TY - JOUR
T1 - Scapulothoracic anatomy for the arthroscopist
AU - Ruland, Louis J.
AU - Ruland, Charles M.
AU - Matthews, Leslie S.
N1 - Funding Information:
Acknowledgment: The authors thank Ronald Wade, Director, Anatomy Board of the State of Maryland, for his assistance in this project and Elaine P. Bulson for editorial support in the preparation of this manuscript.
PY - 1995/2
Y1 - 1995/2
N2 - Because endoscopic management has recently been introduced as treatment for painful subscapular snapping, we designed a cadaveric study to identify the boundaries of the scapulothoracic spaces and the relationship of important neurovascular structures to safe portal sites for arthroscopic surgery. We studied eight fresh, unembalmed cadaveric shoulders by anatomic dissection alone and eight fresh, unembalmed cadaveric shoulders by dissection after arthroscopy. We noted the following findings: (1) the scapulothoracic articulation has two triangular spaces, the serratus anterior space and the subscapularis space, that are divided obliquely by the serratus anterior muscle; (2) the boundaries of the larger serratus anterior space include the chest wall anteriorly, the serratus anterior muscle posteriorly, and the rhomboids medially; (3) the boundaries of the subscapularis space are the serratus anterior muscle anteriorly, the subscapularis muscle posteriorly, and the axilla laterally; and (4) a well-defined bursa occupies the serratus anterior space. Based on these findings, we recommend that portals for arthroscopic surgery should be inferior to the spine of the scapula and three to four fingerbreadths from the vertebral border of the scapula (1) to avoid the neurovascular structures at the superomedial angle of the scapula, (2) to avoid the dorsosacpular nerve and artery, and (3) to prevent perpendicular orientation of the arthroscope to the lateral chest wall.
AB - Because endoscopic management has recently been introduced as treatment for painful subscapular snapping, we designed a cadaveric study to identify the boundaries of the scapulothoracic spaces and the relationship of important neurovascular structures to safe portal sites for arthroscopic surgery. We studied eight fresh, unembalmed cadaveric shoulders by anatomic dissection alone and eight fresh, unembalmed cadaveric shoulders by dissection after arthroscopy. We noted the following findings: (1) the scapulothoracic articulation has two triangular spaces, the serratus anterior space and the subscapularis space, that are divided obliquely by the serratus anterior muscle; (2) the boundaries of the larger serratus anterior space include the chest wall anteriorly, the serratus anterior muscle posteriorly, and the rhomboids medially; (3) the boundaries of the subscapularis space are the serratus anterior muscle anteriorly, the subscapularis muscle posteriorly, and the axilla laterally; and (4) a well-defined bursa occupies the serratus anterior space. Based on these findings, we recommend that portals for arthroscopic surgery should be inferior to the spine of the scapula and three to four fingerbreadths from the vertebral border of the scapula (1) to avoid the neurovascular structures at the superomedial angle of the scapula, (2) to avoid the dorsosacpular nerve and artery, and (3) to prevent perpendicular orientation of the arthroscope to the lateral chest wall.
KW - Scapulothoracic anatomy
KW - Snapping scapula
KW - Subscapular arthroscopy
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U2 - 10.1016/0749-8063(95)90088-8
DO - 10.1016/0749-8063(95)90088-8
M3 - Article
C2 - 7727012
AN - SCOPUS:0028942043
SN - 0749-8063
VL - 11
SP - 52
EP - 56
JO - Arthroscopy: The Journal of Arthroscopic and Related Surgery
JF - Arthroscopy: The Journal of Arthroscopic and Related Surgery
IS - 1
ER -