Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 12, pp 3771–3778 | Cite as

Arthroscopic anatomy medial to the coracoid: an anatomic study of the axillary and musculocutaneous nerves

  • Michael L. Knudsen
  • Jonathan P. BramanEmail author



The purpose of this study was to provide arthroscopic measurements and orientations of the axillary and musculocutaneous nerves medial to the coracoid.


A retrospective chart review of 29 patients undergoing arthroscopic subscapularis repair and arthroscopic cadaveric dissection of 23 shoulders was used to analyze neuroanatomical distances to arthroscopic landmarks and to document the orientations of the axillary and musculocutaneous nerves using a clock face analogy. The clock face data was analyzed by separating the clock face into four quadrants and the frequency of any crossing nerve within each of the four quadrants was then determined.


In vivo, the axillary nerve was found 1.5 ± 0.5 cm medial to the coracoid tip and the musculocutaneous nerve was found 1.6 ± 0.6 cm medial to the coracoid tip. In cadavera, the axillary nerve was found 2.0 ± 0.6 cm medial to the coracoid tip and the musculocutaneous nerve was found 1.5 ± 0.5 cm medial to the coracoid tip. The posterosuperior quadrant of the subcoracoid space contained a crossing nerve in 4 of 29 (13.8%) patients undergoing arthroscopic rotator cuff repair medial to the coracoid, compared to 9 of 23 (39.1%) cadavera undergoing arthroscopic dissection medial to the coracoid. The posteroinferior quadrant contained a crossing nerve in 16 of 29 (55.2%) patients compared to 17 of 23 (73.9%) cadavera.


The axillary and musculocutaneous nerves run in close proximity to the coracoid tip and coracoid arch, most consistently within 1–2 cm medial to these structures, which is closer than has been previously documented in the literature. Crossing nerves are least frequently encountered within the posterosuperior quadrant of the subcoracoid space medial to the coracoid, followed by the posteroinferior quadrant. Arthroscopic dissection of this space should begin in the posterosuperior quadrant and carefully progress to the posteroinferior quadrant to decrease the risk of intraoperative nerve injury. Given the close proximity and frequently encountered nerves in this area, extreme caution must be exercised when working arthroscopically within the subcoracoid space.


Axillary nerve Musculocutaneous nerve Coracoid Anatomy Arthroscopic subscapularis repair Arthroscopic Latarjet 



The authors would like to thank the contributions made by Dr. Denis Clohisy and the Department of Orthopaedic Surgery at the University of Minnesota for the provision of funds and for the acquisition of materials and cadavera for this study. The authors would also like to thank Dr. Jason C. Hibbard and Dr. Michal P. Zlowodzki for their contributions in the assistance of data collection for this study. Lastly, the authors would like to thank Kellie A. Knudsen for her line drawing contributions for this study.


No external funding sources were used in the development of this study.

Compliance with ethical standards

Conflict of interest

Dr. Braman serves as a paid consultant of Zimmer Biomet, unrelated to the subject of this work. Dr. Knudsen does not receive anything of value and does not own any stock in a commercial company or institution related directly or indirectly to the subject of this article.

Ethical approval

This study was approved by the University of Minnesota Institutional Review Board.

Supplementary material

Supplementary material 1 Video 1 This video demonstrates a right shoulder while utilizing an anterolateral viewing portal and an anteroanterolateral working portal. Dissection has already been performed in the subcoracoid space using a combination of sharp and blunt techniques. The dissection was carried down along the anterior surface of the torn subscapularis tendon and under the coracoid arch. The axillary and musculocutaneous nerves are identified medial to the coracoid arch in this video. The strap muscles, or conjoint tendon, are seen to the right of the video and determine the vertical axis of the scope and the apex of the coracoid arch relative to this is considered the 12:00 position. This dissection was performed in a standardized beach chair position with the arm in 60 degrees of forward flexion and 20 degrees of lateral deviation (MP4 14175 KB)


  1. 1.
    Adams CR, Schoolfield JD, Burkhart SS (2008) The results of arthroscopic subscapularis tendon repairs. Arthroscopy 24:1381–1389CrossRefGoogle Scholar
  2. 2.
    Athwal GS, Meislin R, Getz C, Weinstein D, Favorito P (2016) Short-term complications of the arthroscopic Latarjet procedure: a North American experience. Arthroscopy 32:1965–1970CrossRefGoogle Scholar
  3. 3.
    Bartl C, Salzmann GM, Seppel G, Eichhorn S, Holzapfel K, Wörtler K, Imhoff AB (2011) Subscapularis function and structural integrity after arthroscopic repair of isolated subscapularis tears. Am J Sports Med 39:1255–1262CrossRefGoogle Scholar
  4. 4.
    Boileau P, Mercier N, Roussanne Y, Thélu C-É, Old J (2010) Arthroscopic Bankart–Bristow–Latarjet procedure: the development and early results of a safe and reproducible technique. Arthroscopy 26:1434–1450CrossRefGoogle Scholar
  5. 5.
    Burkart AC, Debski RE (2002) Anatomy and function of the glenohumeral ligaments in anterior shoulder instability. Clin Orthop Relat Res. 400:32–39CrossRefGoogle Scholar
  6. 6.
    Burkhart SS, Brady PC (2006) Arthroscopic subscapularis repair: surgical tips and pearls A to Z. Arthroscopy 22:1014–1027CrossRefGoogle Scholar
  7. 7.
    Burkhart SS, Tehrany AM (2002) Arthroscopic subscapularis tendon repair: technique and preliminary results. Arthroscopy 18:454–463CrossRefGoogle Scholar
  8. 8.
    Colvin AC, Shen W, Musahl V, Fu FH (2009) Avoiding pitfalls in anatomic ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 17:956–963CrossRefGoogle Scholar
  9. 9.
    Cooper DE, Arnoczky SP, O’Brien SJ, Warren RF, DiCarlo E, Allen AA (1992) Anatomy, histology, and vascularity of the glenoid labrum. An anatomical study. J Bone Jt Surg Am 74:46–52CrossRefGoogle Scholar
  10. 10.
    Denard PJ, Jiwani AZ, Lädermann A, Burkhart SS (2012) Long-term outcome of a consecutive series of subscapularis tendon tears repaired arthroscopically. Arthroscopy 28:1587–1591CrossRefGoogle Scholar
  11. 11.
    Esmail AN, Getz CL, Schwartz DM, Wierzbowski L, Ramsey ML, Williams GR (2005) Axillary nerve monitoring during arthroscopic shoulder stabilization. Arthroscopy 21:665–671CrossRefGoogle Scholar
  12. 12.
    Fu FH (2008) The clock-face reference: simple but nonanatomic. Arthroscopy 24:1433 (author reply 1434) CrossRefGoogle Scholar
  13. 13.
    Golish SR, Baumfeld JA, Schoderbek RJ, Miller MD (2007) The effect of femoral tunnel starting position on tunnel length in anterior cruciate ligament reconstruction: a cadaveric study. Arthroscopy 23:1187–1192CrossRefGoogle Scholar
  14. 14.
    Ide J, Tokiyoshi A, Hirose J, Mizuta H (2007) Arthroscopic repair of traumatic combined rotator cuff tears involving the subscapularis tendon. J Bone Jt Surg Am 89:2378–2388CrossRefGoogle Scholar
  15. 15.
    Kuntz AF, Raphael I, Dougherty MP, Abboud JA (2014) Arthroscopic subscapularis repair. J Am Acad Orthop Surg 22:80–89PubMedGoogle Scholar
  16. 16.
    Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R (2007) Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Jt Surg Am 89:1184–1193CrossRefGoogle Scholar
  17. 17.
    Lafosse L, Lanz U, Saintmard B, Campens C (2010) Arthroscopic repair of subscapularis tear: surgical technique and results. Orthop Traumatol Surg Res 96:S99–S108CrossRefGoogle Scholar
  18. 18.
    Lafosse L, Lejeune E, Bouchard A, Kakuda C, Gobezie R, Kochhar T (2007) The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Arthroscopy 23:1242.e1–1242.e5CrossRefGoogle Scholar
  19. 19.
    Lanz U, Fullick R, Bongiorno V, Saintmard B, Campens C, Lafosse L (2013) Arthroscopic repair of large subscapularis tendon tears: 2- to 4-year clinical and radiographic outcomes. Arthroscopy 29:1471–1478CrossRefGoogle Scholar
  20. 20.
    Lo IKY, Burkhart SS (2003) The comma sign: an arthroscopic guide to the torn subscapularis tendon. Arthroscopy 19:334–337CrossRefGoogle Scholar
  21. 21.
    Lo IKY, Burkhart SS, Parten PM (2004) Surgery about the coracoid: neurovascular structures at risk. Arthroscopy 20:591–595CrossRefGoogle Scholar
  22. 22.
    Mall N, Chahal J, Heard WM, Bach BR, Bush-Joseph C a., Romeo A a., Verma NN (2012) Outcomes of arthroscopic and open surgical repair of isolated subscapularis tendon tears. Arthroscopy 28:1306–1314CrossRefGoogle Scholar
  23. 23.
    Miller MD, Gerdeman AC, Miller CD, Hart JM, Gaskin CM, Golish SR, Clancy WG (2010) The effects of extra-articular starting point and transtibial femoral drilling on the intra-articular aperture of the tibial tunnel in ACL reconstruction. Am J Sports Med 38:707–712CrossRefGoogle Scholar
  24. 24.
    Nové-Josserand L, Hardy M-B, Leandro Nunes Ogassawara R, Carrillon Y, Godenèche A (2012) Clinical and structural results of arthroscopic repair of isolated subscapularis tear. J Bone Jt Surg Am 94:e125CrossRefGoogle Scholar
  25. 25.
    O’Brien SJ, Neves MC, Arnoczky SP, Rozbruck SR, Dicarlo EF, Warren RF, Schwartz R, Wickiewicz TL (1989) The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am J Sports Med 18:449–456CrossRefGoogle Scholar
  26. 26.
    Pan W-J, Teo Y-S, Chang H-C, Chong K-C, Karim SA (2008) The relationship of the lateral cord of the brachial plexus to the coracoid process during arthroscopic coracoid surgery: a dynamic cadaveric study. Am J Sports Med 36:1998–2001CrossRefGoogle Scholar
  27. 27.
    Raffo CS, Pizzarello P, Richmond JC, Pathare N (2008) A reproducible landmark for the tibial tunnel origin in anterior cruciate ligament reconstruction: avoiding a vertical graft in the coronal plane. Arthroscopy 24:843–845CrossRefGoogle Scholar
  28. 28.
    Rue J-PH, Ghodadra N, Bach BR (2008) Femoral tunnel placement in single-bundle anterior cruciate ligament reconstruction: a cadaveric study relating transtibial lateralized femoral tunnel position to the anteromedial and posterolateral bundle femoral origins of the anterior cruciate ligament. Am J Sports Med 36:73–79CrossRefGoogle Scholar
  29. 29.
    Saito H, Itoi E, Sugaya H, Minagawa H, Yamamoto N, Tuoheti Y (2005) Location of the glenoid defect in shoulders with recurrent anterior dislocation. Am J Sports Med 33:889–893CrossRefGoogle Scholar
  30. 30.
    Tibone J (2016) Editorial commentary: not for the faint of heart: the arthroscopic Latarjet procedure, a North American experience. Arthroscopy 32:1971–1972CrossRefGoogle Scholar
  31. 31.
    Yung SW, Lazarus MD, Harryman DT (1996) Practical guidelines to safe surgery about the subscapularis. J Shoulder Elbows Surg 5:467–470CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryUniversity of MinnesotaMinneapolisUSA

Personalised recommendations