Relationships of the musculocutaneous nerve and the coracobrachialis during coracoid abutment procedure (Latarjet procedure)

Abstract

Lesion of the musculocutaneous nerve is a known complication of the coracoid bone block abutment procedure (Latarjet-Bristow). From this study we know that they are due to lengthening of the nerve and modification of the penetration angle of the nerve into the coracobrachialis. We also infer that some motor nerve destined to the coracobrachialis might be damaged during the proximal medial release of the muscle after the detachment of the pectoralis minor muscle.

The role of arthroscopy in the revision of failed Latarjet procedures

“…According to some authors, the majority of causes relating to recurrence can be attributed to diagnostic error, underestimation of capsular laxity and non-recognition of the multidirectional instability [32]. The Latarjet procedure has shown a very low recurrence rate, but can present significant complications such as neurological or vascular lesions [8], mobilization or breakage of screws, absorption or non-union of the bone block, glenohumeral arthritis, infections, fat degeneration of the subscapularis due to iatrogenic damage [6-8, 10, 27], as well as the persistence of pain in some cases [6,13,17,28,29]. When performing this particular technique, splitting of the subscapularis so as not to denervate it and fixation of the coracoid to the anterior- inferior portion of the glenoid rim is thought to be beneficial [29,33].…”

“…Several techniques have been described for the treatment of glenohumeral instability and each one poses its own, precise indications [1][2][3][4][5]. However, none of these techniques can definitively and optimally stabilize this joint [6][7][8][9][10][11][12][13][14]. The rate of recurrent instability after surgery varies between 0 and 30% depending on the authors, the nature of follow-up examination and the types of treatment used [13,15,16].…”

Traumatic Anterior Shoulder Instability: Part I. General Concepts and Proper Management

“…Short-term complications include infection, recurrent glenohumeral instability, and neurologic injury [ 81 , 94 , 95 ]. Neurological impairment of the musculocutaneous nerve is avoided by gently manipulating the coracoid process during preparation and avoiding excessive medial dissection [ 96 ]. The suprascapular nerve is at risk posteriorly from placement of the screws and can be avoided by parallel screw placement within 10° of the glenoid in the axial plane (Fig.…”

Nerves of the Upper Extremity

“…Typically, the nerve to the coracobrachialis entered the muscle 3 cm below the coracoid process, whereas the musculocutaneous nerve enters the muscle at least 5-6 cm below the coracoid process and often much further distally (Flatow et al 1989;Clavert et al 2009;Pianezza et al 2012). …”

“…The nerve to the coracobrachialis may ramify into multiple branches prior to the insertion on the coracobrachialis muscle, with two-thirds having two to three branches (Clavert et al 2009). …”