Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 25, Issue 10, pp 3289–3295 | Cite as

Effect of scapular external rotation on the axillary nerve during the arthroscopic Latarjet procedure: an anatomical investigation

  • Felipe Reinares
  • Jean-David Werthel
  • Constantina Moraiti
  • Philippe Valenti
Shoulder
First Online:
Received:
Accepted:

Abstract

Purpose

The first purpose of this study is to measure the distance between the axillary nerve and the exit point of K-wires placed retrograde through the glenoid in the setting of an arthroscopic Latarjet procedure. The second objective is to evaluate whether manual external rotation of the scapula alters that distance.

Methods

In seven fresh–frozen specimens, two 2.0-mm K-wires were drilled through the glenoid using an arthroscopic Latarjet retrograde glenoid guide. These were drilled into the glenoid at the 7- and 8-o’clock positions (right shoulders) and at the 4- and 5-o’clock positions (left). K-wires were oriented parallel to the glenoid articular surface and perpendicular to the long superoinferior axis of the glenoid, 7 mm medial to the joint surface. Two independent evaluators measured the distances between the axillary nerve and the exit point of the K-wires in the horizontal plane (AKHS for the superior K-wire and AKHI for the inferior K-wire) and in the vertical plane (AKV). Measurements were taken with the scapula left free and were repeated with the scapula placed at 15° and 30° of external rotation.

Results

With the scapula left free, scapular external rotation was 34° ± 2.3°. In this position, the AKHS was 2.5 ± 1.6, 6.3 ± 1.2 mm at 15° of external rotation (ER) and 11.4 ± 1.4 mm at 30° ER. The AKHI distance was 0.37 ± 1.6, 3.4 ± 1.4 and 10.6 ± 2.1 mm, respectively, for the scapula left free, at 15° ER and 30° of ER. The AKV distances were, respectively, 0.12 ± 0.2, 4.9 ± 1.6 and 9.9 ± 1.7 mm. The increase in all distances was statistically significant (p < 0.001).

Conclusion

Increasing scapular external rotation significantly increases the distance between the axillary nerve and the exit point of the K-wires, increasing the margin of safety during this procedure. Therefore, increased external rotation of the scapula could be an effective tool to decrease the risk of iatrogenic axillary nerve injury.

Level of evidence

Cadaveric study, Level V.

Keywords

Shoulder arthroscopy Arthroscopic Latarjet procedure Axillary nerve Nerve injury Shoulder instability 
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Notes

Compliance with ethical standards

Disclosures

Philippe Valenti receives royalties for shoulder prosthesis design from FH Orthopedics. The other authors, their immediate families and any research foundations with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.

Ethical standard

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  • Felipe Reinares
    • 1
  • Jean-David Werthel
    • 1
  • Constantina Moraiti
    • 1
  • Philippe Valenti
    • 1
  1. 1.Department of Shoulder Surgery, Institut de la MainClinique JouvenetParisFrance

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