title: The safe zone for avoiding suprascapular nerve injury in bone block procedures for shoulder instability. A cadaveric study.
abstract: OBJECTIVE
  The purpose of the study is to identify the safe zone in which the surgeon can place the screws for fixation of the coracoid graft during the Latarjet procedure to avoid injuries of the suprascapular nerve with the shoulder in internal and external rotation.
  
  
  METHODS
  The dissection on twelve fresh-frozen shoulders was performed according to a standard posterior approach to the gleno-humeral joint. The suprascapular nerve and its branches for the infraspinatus muscle were identified at the spinoglenoid notch region. Then, the distance between the glenoid and the suprascapular nerve at the spinoglenoid notch region was measured by using a ruler with the shoulder at 90° internal rotation and at 90° of external rotation.
  
  
  RESULTS
  The median distance between the glenoid and the suprascapular nerve was 12 mm (range 6-15 mm) with the shoulder at 90° of internal rotation and 19 mm (range 11-23 mm) with the shoulder at 90° of external rotation. The distance between the glenoid and the suprascapular nerve was statistically significantly greater with the shoulder at 90° of external rotation than 90° of internal rotation (P = 0.002).
  
  
  CONCLUSIONS
  The suprascapular nerve is furthest away from the glenoid with the shoulder at 90° of external rotation. Therefore, the placement of screws in external rotation of the humerus during glenoid bone block procedures likely reduces the risk of iatrogenic injuries of the suprascapular nerve.
authors: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Rome, Italy. g.longo@unicampus.it.
authors: Umile Giuseppe
authors: UG
authors: Longo
authors: Orthopaedic Department, School of Medicine, University CEU Campus de Montepríncipe, 28886, Boadilla del Monte, Madrid, Spain.
authors: Francisco
authors: F
authors: Forriol
authors: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
authors: Mattia
authors: M
authors: Loppini
authors: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
authors: Angela
authors: A
authors: Lanotte
authors: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
authors: Giuseppe
authors: G
authors: Salvatore
authors: Barts and The London School of Medicine and Dentistry, William Harvey Research Institute, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, UK.
authors: Nicola
authors: N
authors: Maffulli
authors: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
authors: Vincenzo
authors: V
authors: Denaro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001134:Arm Injuries / Q000601:surgery*; D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D059348:Peripheral Nerve Injuries / Q000209:etiology / Q000517:prevention & control*; D017006:Rotator Cuff / Q000601:surgery*; D012540:Scapula / Q000294:innervation*; D012785:Shoulder Joint / Q000601:surgery*