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Nerve supply of the subscapularis during anterior shoulder surgery: definition of a potential risk area

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Abstract

Purpose

The purpose of the study was to evaluate the position of the subscapular nerves relative to surgical landmarks during exposure and to analyze the pattern of innervation of the subscapularis to avoid injury during anterior shoulder surgery.

Methods

20 embalmed human cadaveric shoulder specimens were used in the study. The muscular insertions of the subscapular nerves were marked and their closest branches to the musculotendinous junction and the coracoid process were measured in horizontal and vertical distances. In addition, the innervation pattern of each specimen was documented.

Results

14/20 specimens showed an innervation of the subscapularis with an upper, middle and lower subscapular nerve branch. Even though the nerve branches were in average more than 2 cm medial to the musculotendinous junction, minimal distances of 1.1–1.3 cm were found. The mean vertical distance as measured from the medial base of the coracoid to the nerve innervation point into the muscle was 0.7 cm for the upper nerve branch, 2.2 cm for the middle nerve branch and 4.4 cm for the lower nerve branch.

Conclusions

The subscapularis has a variable nerve supply, which increases the risk of muscle denervation during open shoulder surgery. Dissection or release should be avoided at the anterior aspect of the subscapularis muscle more than 1 cm medial to the musculotendinous junction. In approaches with a horizontal incision of the subscapularis, splitting should be performed at a vertical distance of 3.2–3.6 cm to the coracoid base to avoid iatrogenic subscapular nerve injuries.

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Authors and Affiliations

  1. Center for Orthopedic and Trauma Surgery, University Medical Center, Kerpenerstr. 62, 50937, Cologne, Germany

    Tim Leschinger, Michael Hackl, Lars Peter Müller & Kilian Wegmann

  2. Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany

    Tim Leschinger, Michael Hackl, Martin Scaal, Lars Peter Müller & Kilian Wegmann

  3. Institute of Anatomy II, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany

    Martin Scaal

  4. Clinic for Orthopedics and Trauma Surgery, University of Heidelberg, Schlierbacher, Landstraße 200a, 69118, Heidelberg, Germany

    Felix Zeifang

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  1. Tim Leschinger
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  2. Michael Hackl
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  3. Felix Zeifang
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Corresponding author

Correspondence to Tim Leschinger.

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Institutional review board

The Ethics Commission of the Faculty of Medicine of Cologne University has approved the study (16-034).

Conflict of interest

Tim Leschinger, Michael Hackl, Martin Scaal, Felix Zeifang, Lars Peter Müller, and Kilian Wegmann: None. These authors, their immediate families, and any research foundation 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.

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Leschinger, T., Hackl, M., Zeifang, F. et al. Nerve supply of the subscapularis during anterior shoulder surgery: definition of a potential risk area. Arch Orthop Trauma Surg 137, 135–140 (2017). https://doi.org/10.1007/s00402-016-2585-7

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  • DOI: https://doi.org/10.1007/s00402-016-2585-7

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