title: Brachial plexus endoscopic dissection and correlation with open dissection.
abstract: Shoulder endoscopy is evolving and becoming extra-articular. More and more procedures are taking place in the area of the brachial plexus (BP). We carried out an anatomical study to describe the endoscopic anatomy of the BP and the technique used to dissect and expose the BP endoscopically. Thirteen fresh cadavers were dissected. We first performed an endoscopic dissection of the BP, using classical extra-articular shoulder arthroscopy portals. Through each portal, we dissected as many structures as possible and identified them. We then did an open dissection to corroborate the endoscopic findings and to look for damage to the neighboring structures. In the supraclavicular area, we were able to expose the C5, C6 and C7 roots, and the superior and middle trunks in 11 of 13 specimens through two transtrapezial portals by following the suprascapular nerve. The entire infraclavicular portion of the BP (except the medial cord and its branches) was exposed in 11 of 13 specimens. The approach to the infraclavicular portion of the BP led directly to the lateral and posterior cords, but the axillary artery hid the medial cord. The musculocutaneous nerve was the first nerve encountered when dissecting medially from the anterior aspect of the coracoid process. The axillary nerve was the first nerve encountered when following the anterior border of the subscapularis medially from the posterior aspect of the coracoid process. Knowledge of the endoscopic anatomy of the BP is mandatory to expose and protect this structure while performing advanced arthroscopic shoulder procedures.
authors.affiliation: Hand, Upper Limb and Peripheral Nerve Surgery Department, European Georges-Pompidou Hospital, 20, rue Leblanc, 75908 Paris cedex, France. Electronic address: lafosse.thibault@gmail.com.
authors.forename: T
authors.initials: T
authors.lastname: Lafosse
authors.affiliation: Hand, Upper Limb and Peripheral Nerve Surgery Department, European Georges-Pompidou Hospital, 20, rue Leblanc, 75908 Paris cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Masmejean
authors.affiliation: Hand, Upper Limb and Peripheral Nerve Surgery Department, European Georges-Pompidou Hospital, 20, rue Leblanc, 75908 Paris cedex, France.
authors.forename: T
authors.initials: T
authors.lastname: Bihel
authors.affiliation: Alps Surgery Institute, 74000 Annecy, France.
authors.forename: L
authors.initials: L
authors.lastname: Lafosse
mesh_terms: D001182:Arthroscopy; D001917:Brachial Plexus / Q000033:anatomy & histology*; D002102:Cadaver; D002574:Cervical Vertebrae / Q000033:anatomy & histology; D006801:Humans; D044583:Neuroendoscopy; D012785:Shoulder Joint / Q000601:surgery; D013126:Spinal Nerve Roots / Q000033:anatomy & histology
keywords: Anatomical study; Brachial plexus; Endoscopie périarticulaire; Periarticular endoscopy; Plexus brachial; Étude anatomique