Optimising safe margins in shoulder surgeries: a cadaveric study on brachial plexus nerves with anthropometric and movement correlation

Purpose Shoulder surgeries, vital for diverse pathologies, pose a risk of iatrogenic nerve damage. Existing literature lacks diverse bone landmark–specific nerve position data. The purpose of this study is to address this gap by investigating such relationships. Method This cadaveric study examines...

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Bibliographic Details
Published in:International orthopaedics 2024-07, Vol.48 (7), p.1809-1813
Main Authors: Kodandapani, K., Sangani, Karthik, Chakrapani, Arjun, Vedapriya, Aparna K.
Format: Article
Language:English
Subjects:
Medicine
Medicine & Public Health
Original Paper
Orthopedics
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Summary:Purpose Shoulder surgeries, vital for diverse pathologies, pose a risk of iatrogenic nerve damage. Existing literature lacks diverse bone landmark–specific nerve position data. The purpose of this study is to address this gap by investigating such relationships. Method This cadaveric study examines axillary, radial and suprascapular nerves’ relation with acromion, coracoid and greater tuberosity of the humerus (GT). It also correlates this data with humeral lengths and explores nerve dynamics in relation to arm positions. Results The mean distance from the axillary nerve to (i) GT was 4.38 cm (range 3.32–5.44, SD 0.53), (ii) acromion was 6.42 cm (range 5.03–7.8, SD 0.694) and (iii) coracoid process was 4.3 cm (range 2.76–5.84, SD 0.769). Abduction brought the nerve closer by 0.36 cm, 0.35 cm and 0.53 cm, respectively. The mean distance from radial nerve to (i) GT was 5.46 cm (range 3.78–7.14, SD 0.839), (ii) acromion was 7.82 cm (range 5.4–10.24, SD 1.21) and (iii) tip of the coracoid process was 6.09 cm (range 4.07–8.11 cm, SD 1.01). The mean distance from the suprascapular nerve to the acromion was 4.2 cm (range 3.1–5.4, SD 0.575). The mean humeral length was noted to be 27.83 cm (range 25.3–30.7, SD 1.13). There was no significant correlation between these distances and humeral lengths. Conclusion It is essential to exercise caution to avoid axillary nerve damage during the abduction manoeuvre, as its distance from the greater tuberosity and tip of the coracoid process has shown a significant reduction. The safe margins, in relation to the length of the humerus and consequently the patient’s stature, exhibit no significant variation. In situations where the greater tuberosity (GT) and the border of the acromion are inaccessible due to reasons such as trauma, the tip of the coracoid process can serve as a dependable bone landmark for establishing a secure surgical margin.
ISSN:0341-2695
1432-5195
1432-5195
DOI:10.1007/s00264-024-06163-y