Abstract
Purpose
Implantation of a reverse total shoulder arthroplasty (rTSA) places the axillary and
suprascapular nerves at risk. The aim of this anatomic study was to digitally analyse
the location of these nerves in relation to bony landmarks in order to predict their
path and thereby help to reduce the risk of neurological complications during the
procedure.
Methods
A total of 22 human cadaveric shoulder specimens were used in this study. The axillary
and suprascapular nerves were dissected, and radiopaque threads were sutured onto
the nerves without mobilizing the nerves from their native paths. Then, 3D X-ray scans
of the specimens were performed, and the distance of the nerves to bony landmarks
at the humerus and the glenoid were measured.
Results
The distance of the inferior glenoid rim to the axillary nerve averaged 13.6 mm (5.8–27.0 mm, ±5.1 mm). In the anteroposterior direction, the distance between the axillary nerve and
the humeral metaphysis averaged 8.1 mm (0.6–21.3 mm, ±6.5 mm).
The distance of the glenoid centre to the suprascapular nerve passing point under
the transverse scapular ligament measured 28.4 mm (18.9–35.1 mm, ±3.8 mm) in the mediolateral direction and 10.8 mm (−4.8 to 25.3 mm, ±6.1 mm) in the anteroposterior direction. The distance to the spinoglenoid notch was 16.6 mm (11.1–24.9 mm, ±3.4 mm) in the mediolateral direction and −11.8 mm posterior (−19.3 to −4.7 mm, ±4.7 mm) in the anteroposterior direction.
Conclusions
Implantation of rTSA components endangers the axillary nerve because of its proximity
to the humeral metaphysis and the inferior glenoid rim. Posterior and superior drilling
and extraosseous screw placement during glenoid baseplate implantation in rTSA place
the suprascapular nerve at risk, with safe zones to the nerve passing the spinoglenoid
notch of 11 mm and to the suprascapular notch of 19 mm.
Keywords
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Article info
Publication history
Published online: June 28, 2017
Accepted:
June 26,
2017
Footnotes
☆The Ethics Commission of the Faculty of Medicine of Cologne University has approved the study 14-433.
Identification
Copyright
© 2017 Elsevier Ltd. All rights reserved.
