Download PDF
CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2025; 60(01): s00441800921
DOI: 10.1055/s-0044-1800921
Artigo Original

Neurological Anatomy Applied to the Deltopectoral Surgical Approach: Safety Parameters in the Latarjet Procedure

Article in several languages: português | English
André Leonardo Nogueira Farias 
1   Grupo de Ombro e Cotovelo, Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual (HSPE), São Paulo, SP, Brasil
,
Leonardo Yabu Tanaka 
1   Grupo de Ombro e Cotovelo, Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual (HSPE), São Paulo, SP, Brasil
,
Larissa Vasconcelos de Castro 
1   Grupo de Ombro e Cotovelo, Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual (HSPE), São Paulo, SP, Brasil
,
Miguel Pereira da Costa 
1   Grupo de Ombro e Cotovelo, Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual (HSPE), São Paulo, SP, Brasil
,
Romulo Brasil Filho 
1   Grupo de Ombro e Cotovelo, Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual (HSPE), São Paulo, SP, Brasil
,
Antonio Carlos Tenor Júnior 
1   Grupo de Ombro e Cotovelo, Serviço de Ortopedia e Traumatologia, Hospital do Servidor Público Estadual (HSPE), São Paulo, SP, Brasil
› Author Affiliations Financial Support The authors declare that they did not receive financial support from agencies in the public, private, or non-profit sectors to conduct the present study.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective The present study aims to identify neurological safety parameters for performing the Latarjet procedure via the deltopectoral approach in a cross-sectional and prospective analysis of fresh cadavers.

Methods We dissected 12 shoulders from cadavers in good condition with no history of previous surgery or musculoskeletal dysfunction. Their mean age, height, weight, and body mass index (BMI) were the following: 75.33 (41–97) years, 168.81 (149–186) cm, 60.35 (26–77) kg, and 21.38 (11.71–34.22) kg/m2, respectively. We identified the anatomical landmark of the deltopectoral approach (medial glenoid rim, MGR) and measured its distance from the axillary, musculocutaneous, and subscapular nerves.

Results We obtained the following measurements in neutral rotation and 40° external rotation, respectively: distance from the MGR to the axillary nerve (AN), 2.87 cm and 2.58 cm (p = 0.29); distance from the MGR to the musculocutaneous nerve (MCN), 2.70 cm and 2.54 cm (p = 0.36); distance from the MGR to the upper subscapular nerve (USSN), 3.83 cm and 4.00 cm (p = 0.30); distance from the MGR to the middle subscapular nerve (MSSN), 3.50 cm and 3.50 cm (p = 1.00); and distance from the MGR to the lower subscapular nerve (LSSN), 3.00 cm and 2.83 cm (p = 0.36).

Conclusion The deltopectoral approach is safe. However, in the Latarjet procedure, subscapularis muscle splitting and coracoid graft fixation require attention and caution due to the small distance to the adjacent nerves. These precautions can avoid major postoperative complications.

Keywords

scapula/anatomy & histology - scapula/surgery - shoulder

Work carried out at the Shoulder and Elbow Group, Orthopedics and Traumatology Service, Hospital do Servidor Público Estadual (HSPE), São Paulo, SP, Brazil.




Publication History

Received: 29 February 2024

Accepted: 30 August 2024

Article published online:
12 March 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Bibliographical Record
André Leonardo Nogueira Farias, Leonardo Yabu Tanaka, Larissa Vasconcelos de Castro, Miguel Pereira da Costa, Romulo Brasil Filho, Antonio Carlos Tenor Júnior. Anatomia neurológica aplicada à abordagem cirúrgica deltopeitoral: Parâmetros de segurança no procedimento de Latarjet. Rev Bras Ortop (Sao Paulo) 2025; 60: s00441800921.
DOI: 10.1055/s-0044-1800921
 

  • Referências

  • 1 Almeida A, Menegotto SM, Almeida NC, Agostini AP, Almeida LA. Analysis of postoperative monitoring of patients undergoing shoulder arthroscopy for anterior instability. Rev Bras Ortop 2017; 52 (04) 458-462
    PubMedSearch in Google Scholar
  • 2 Ho E, Cofield RH, Balm MR, Hattrup SJ, Rowland CM. Neurologic complications of surgery for anterior shoulder instability. J Shoulder Elbow Surg 1999; 8 (03) 266-270
    CrossrefPubMedSearch in Google Scholar
  • 3 Nam YS, Jeong JJ, Han SH. et al. An anatomic and clinical study of the suprascapular and axillary nerve blocks for shoulder arthroscopy. J Shoulder Elbow Surg 2011; 20 (07) 1061-1068
    CrossrefPubMedSearch in Google Scholar
  • 4 Yung SW, Lazarus MD, Harryman II DT. Practical guidelines to safe surgery about the subscapularis. J Shoulder Elbow Surg 1996; 5 (06) 467-470
    CrossrefPubMedSearch in Google Scholar
  • 5 Rockwood Jr CA, Matsen FA. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint. In: Rockwood CA, Wirth MA, Fehringer EV, Matsen FA, Sperling JW, Lippitt SB. MD. eds. Rockwood and Matsen's The Shoulder. 5th ed.. Philadelphia: Elsevier; 2017: 1-34
    Search in Google Scholar
  • 6 David J. Cintura Peitoral e Membro Superior. In: Anatomia de Gray. 40ª ed.. Elsevier Churchill Livingstone; 2008: 821
    Search in Google Scholar
  • 7 Caetano EB. Bases anatômicas e funcionais das cirurgias do membro superior. Rio de Janeiro: MedBook; 2010
    Search in Google Scholar
  • 8 Correia RGM. Avaliação funcional e por imagem do músculo subescapular em pacientes submetidos à cirurgia de Latarjet com preservação da inserção tendínea [tese]. Rio de Janeiro: Instituto Nacional de Traumatologia e Ortopedia; 2020
    Search in Google Scholar
  • 9 Cohen M, Fonseca R, Gribel B, Galvão MV, Monteiro M, Motta Filho G. Incidence and Risk Factors of the Complications Related to the Latarjet Surgery. Rev Bras Ortop 2021; 56 (03) 307-312
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Kawakami EFKI, Godoy GP, Cohen MT. et al. Evaluation of Screws Positioning in Latarjet Surgery: Is There a Correlation between Parallelism to Glenoid and Radiographic Complications?. Rev Bras Ortop 2022; 58 (06) e876-e884
    Search in Google Scholar
  • 11 Gracitelli MEC, Ferreira Neto AA, Benegas E, Malavolta EA, Sunada EE, Assunção JH. Procedimento de latarjet artroscópico: avaliação da segurança em cadáveres. Acta Ortop Bras 2013; 21 (03) 139-143
    CrossrefPubMedSearch in Google Scholar
  • 12 Lafosse L, Boyle S. Arthroscopic Latarjet procedure. J Shoulder Elbow Surg 2010; 19 (2, Suppl) 2-12
    CrossrefPubMedSearch in Google Scholar
  • 13 Maldonado AA, Howe BM, Lawton R, Bishop AT, Shin AY, Spinner RJ. Anatomical Study of the Axillary Nerve: Description of a Surgical Blind Zone. Plast Reconstr Surg 2016; 138 (02) 419-426
    CrossrefPubMedSearch in Google Scholar
  • 14 Gupta A, Delaney R, Petkin K, Lafosse L. Complications of the Latarjet procedure. Curr Rev Musculoskelet Med 2015; 8 (01) 59-66
    CrossrefPubMedSearch in Google Scholar
  • 15 Domos P, Lunini E, Walch G. Contraindications and complications of the Latarjet procedure. Shoulder Elbow 2018; 10 (01) 15-24
    CrossrefPubMedSearch in Google Scholar
  • 16 Ferreira Filho AA, Malavolta EA, Gracitelli MEC. et al. Tratamento da luxação anterior recidivante do ombro pela técnica de Bristow-Latarjet. Acta Ortop Bras 2021; 29 (01) 39-44
    CrossrefPubMedSearch in Google Scholar
  • 17 da Silva LA, da Costa Lima ÁG, Kautsky RM, Santos PD, do Val Sella G, Checchia SL. Evaluation of the results and complications of the Latarjet procedure for recurrent anterior dislocation of the shoulder. Rev Bras Ortop 2015; 50 (06) 652-659
    CrossrefPubMedSearch in Google Scholar
  • 18 Coifman I, Valencia M, Ariza A, Clascá F, Calvo E. Técnica de Latarjet para la inestabilidad anterior de hombro: implicaciones en la inervación del músculo subescapular. Rev Esp Cir Ortop Traumatol 2024; 68 (01) 1-8 https://www.elsevier.es/es-revista-revista-espanola-cirugia-ortopedica-traumatologia-129-pdf-S1888441523000012
    PubMedSearch in Google Scholar
  • 19 LaPrade CM, Bernhardson AS, Aman ZS. et al. Changes in the Neurovascular Anatomy of the Shoulder After an Open Latarjet Procedure: Defining a Surgical Safe Zone. Am J Sports Med 2018; 46 (09) 2185-2191
    CrossrefPubMedSearch in Google Scholar
  • 20 Shah AA, Butler RB, Romanowski J, Goel D, Karadagli D, Warner JJ. Short-term complications of the Latarjet procedure. J Bone Joint Surg Am 2012; 94 (06) 495-501
    CrossrefPubMedSearch in Google Scholar
  • 21 Raiss P, Campagnoli A, Bachmaier S, Anderl M, Wittmann T. The Subscapularis-Sparing “Flipped Latarjet” Procedure. Arthrosc Tech 2024; 13 (04) 102899
    CrossrefPubMedSearch in Google Scholar
  • 22 Azizi S, Urbanschitz L, Bensler S, Lenz CG, Borbas P, Eid K. Structural and Functional Results of Subscapularis and Conjoint Tendon After Latarjet Procedure at 8-Year Average Follow-up. Am J Sports Med 2022; 50 (02) 321-326
    CrossrefPubMedSearch in Google Scholar
  • 23 Ernstbrunner L, Waltenspül M, Suter C, El-Nashar R, Scherr J, Wieser K. Primary Open Latarjet Procedure Results in Functional Differences but No Structural Changes in Subscapularis Muscle Quality vs the Healthy Contralateral Shoulder at Long-term Follow-up. Am J Sports Med 2022; 50 (06) 1495-1502
    CrossrefPubMedSearch in Google Scholar
  • 24 Davey MS, Davey MG, Hurley ET, Mullett H. Subscapularis management during open Latarjet procedure: does subscapularis split versus tenotomy matter? A systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31 (10) 2169-2175
    CrossrefPubMedSearch in Google Scholar