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Internal rotation of the shoulder in the beach chair position may increase the risk of iatrogenic suprascapular nerve injury at the spinoglenoid notch during surgical treatment for shoulder instability

  • SHOULDER
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Suprascapular nerve (SN) at the spinoglenoid notch is a mobile structure which is vulnerable to iatrogenic injury from screw or guidewire penetration during shoulder surgery such as Latarjet procedure or SLAP/Bankart repairs. The primary objective is to identify the distance between posterior glenoid and SN in different shoulder abduction and rotation. The secondary objective is to identify the distance in standard lateral decubitus position.

Methods

Nineteen shoulders from 10 Thiel embalmed soft cadavers were used in this study. The dissection of posterior shoulder was done to identify the SN at spinoglenoid notch. The distance between the posterior glenoid rim and the SN was measured. In beach chair position, the SN distance from six combinations of shoulder position was obtained: adduction/90° internal rotation (ADIR), adduction/neutral rotation (ADN), adduction/90° external rotation (ADER), 45° abduction/90° internal rotation (ABIR), 45° abduction/neutral rotation (ABN), 45° abduction/90° external rotation (ABER). Subsequently, the suprascapular nerve distance was measured in standard lateral decubitus position with 10 lbs. longitudinal traction.

Results

In the beach chair position with the shoulder in adduction, the mean distances between the glenoid and the SN in ADIR, ADN and ADER were 15.0 ± 3.3, 19.3 ± 2.6 and 19.5 ± 3.1 mm, respectively. During shoulder abduction, the mean distances when the shoulder was in ABIR, ABN and ABER were 15.2 ± 3.4, 19.4 ± 3.0 and 19.3 ± 2.6 mm, respectively. The mean distance for the lateral decubitus position was 19.3 ± 2.4 mm. The distance between the glenoid and SN was significantly shorter when the shoulder was positioned in internal rotation than in neutral (p < 0.001) or external rotation (p < 0.001) when compared to the same shoulder abduction position. The lateral decubitus position had comparable SN distance with the shoulder position of abduction/neutral rotation in beach chair position.

Conclusion

The SN was closest to posterior glenoid rim if the shoulder was in internal rotation. Therefore, shoulder internal rotation must be avoided during guidewire and cannulated screw placement in the Latarjet procedure and drill bit insertion during anchor placement in SLAP/Bankart repair.

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Acknowledgements

The authors would like to thank the following people for helping us finalize the project: Vanasiri Kuptniratsaikul, Wantanun Lorwatthanakitchai, Thanaphum Osothcharoenphol, Chitapoom Choentrakool, Chayanin Lertmahandpueti. In addition, we wish to show our appreciation to Dr.Chaiwat Chuaychoosakoon for the wise suggestions.

Funding

The authors declare no external funding.

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Authors and Affiliations

  1. Faculty of Medicine, Academic Affair, Chulalongkorn University, Bangkok, Thailand

    Trai Promsang

  2. Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, 1873 Rama IV Rd, Pathumwan, Bangkok, 10330, Thailand

    Danaithep Limskul, Songthai Moonwong, Puchong Kulrat, Somsak Kuptniratsaikul & Thun Itthipanichpong

  3. Department of Orthopaedics, Veterans General Hospital, Bangkok, Thailand

    Kitiphong Kongrukgreatiyos

Authors
  1. Trai Promsang
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  2. Danaithep Limskul
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  3. Songthai Moonwong
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  4. Puchong Kulrat
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  5. Kitiphong Kongrukgreatiyos
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  6. Somsak Kuptniratsaikul
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  7. Thun Itthipanichpong
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Contributions

TP worked on research design. DL analyzed collected data. SM and PK assisted in data measurement. KK reviewed and made corrections to the manuscript. SK orchestrated overall flow of the research. TI wrote the manuscript and handle submission.

Corresponding author

Correspondence to Thun Itthipanichpong.

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Conflict of interest

All the authors have no commercial associations that might pose a conflict of interest in connection with the submitted article.

Ethical approval

IRB No.471/64 was approved from Institutional Review Board, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Informed consent

The use of the cadavers in this study was approved by the Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

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Promsang, T., Limskul, D., Moonwong, S. et al. Internal rotation of the shoulder in the beach chair position may increase the risk of iatrogenic suprascapular nerve injury at the spinoglenoid notch during surgical treatment for shoulder instability. Knee Surg Sports Traumatol Arthrosc 31, 193–198 (2023). https://doi.org/10.1007/s00167-022-07041-z

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  • DOI: https://doi.org/10.1007/s00167-022-07041-z

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