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Effects of the adducted or abducted position of the arm on the course of the musculocutaneous nerve during anterior approaches to the shoulder

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Abstract

Nerve injury is a common complication during anterior shoulder surgery. The purpose of the study was to evaluate the musculocutaneous nerve (MN) anatomically and to clarify the relationship of the MN to the glenoid labrum and coracoid process in different arm positions. The study was carried out on 40 shoulders of 20 adult cadavers fixed in 10% formaldehyde. The minimum distance of the MN at the entrance point of the nerve into the coracobrachialis to the anteromedial aspect of the coracoid tip and the distance between the MN and the top, middle, and inferior points of the glenoid labrum were measured. All measurements were performed with a digital caliper while the arm was in a neutral position, 45° and 90° of abduction, 90° of abduction-internal rotation and 90° of abduction-external rotation to evaluate whether arm position effects the results statistically or not. The results demonstrated that the position of the arm significantly changes the distance between the coracoid process (CP) and the MN or its cord. The change in distance between the glenoid labrum and the MN or its cord was also statistically significant. The distance between the CP and MN was greatest when the arm was abducted to 45° (mean 3.4 cm) and least when the arm was positioned to 90° of abduction-internal rotation (mean 2.0 cm). While the distance between the MN and the coracoid process was least at 90° of abduction and internal rotation, the distance between the MN and glenoid labrum was lest with 90° of abduction and external rotation. The distance between the glenoid labrum and MN was greatest with 45° of abduction. The results of this study might be of use in avoiding the MN especially during Bristlow operations and certain rotator cuff procedures. Transferring the coracoid process during Bristow operations or placing arthroscopic portals when the arm is abducted to 45° appears to be the safest position in terms of MN injury. Based on our results, when the arm needs to be abducted to 90° during operation, externally rotating it may decrease the tension on the brachial plexus thus increasing the distance between the MN and the portals or retractors.

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Authors and Affiliations

  1. Department of Anatomy, School of Medicine, Ankara University, Ankara, Turkey

    Nihal Apaydin, Tulin Sen, Ibrahim Tekdemir & Alaittin Elhan

  2. 3rd Orthopaedics and Traumatology Clinic, Diskapi Yildirim Beyazid Training and Research Hospital, Ankara, Turkey

    Murat Bozkurt

  3. Department of Anatomical Sciences, School of Medicine, St George’s University, Grenada, West Indies

    Marios Loukas

  4. Department of Education and Development, Harvard Medical School, Boston, MA, USA

    Marios Loukas

  5. Department of Cell Biology, University of Alabama at Birmingham, Birmingham, AL, USA

    R. Shane Tubbs

  6. 1st Orthopaedics and Traumatology Clinic, Ataturk Training and Research Hospital, Ankara, Turkey

    Mahmut Ugurlu

  7. Tirebolu Sokak, Omrumce Apt., 27/18, Yukariayranci, 06550, Ankara, Turkey

    Murat Bozkurt

Authors
  1. Nihal Apaydin
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  2. Murat Bozkurt
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  3. Tulin Sen
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  4. Marios Loukas
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  5. R. Shane Tubbs
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  6. Mahmut Ugurlu
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  7. Ibrahim Tekdemir
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  8. Alaittin Elhan
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Correspondence to Murat Bozkurt.

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Apaydin, N., Bozkurt, M., Sen, T. et al. Effects of the adducted or abducted position of the arm on the course of the musculocutaneous nerve during anterior approaches to the shoulder. Surg Radiol Anat 30, 355–360 (2008). https://doi.org/10.1007/s00276-008-0336-3

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  • DOI: https://doi.org/10.1007/s00276-008-0336-3

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