Complete subscapularis tendon visualization and axillary nerve identification by arthroscopic technique

Abstract

The authors explain how one can view the greatest part of the subscapularis tendon from the subacromial aspect. From the articular aspect, it is possible to see only about one third of its entire surface. We also describe the standardized surgical technique used to obtain this visualization. To visualize the greatest possible surface of the tendon, it is necessary to make a trip to the subacromial space starting from the coracoacromial ligament, which leads us to the key structure: the coracoid. Having reached the coracoid, one goes further, following the conjoined tendon under which the subscapularis tendon is located. This last part of the trip takes place in a dark and potentially dangerous area because of its proximity to noble structures. In fact, the axillary nerve is easily identified on the way. Arthroscopic visualization of the greatest part of the subscapularis tendon is possible from the subacromial space. The technique is standard and follows a well-defined path. The exploration and conquest of this dark space through arthroscopy can open new frontiers both in knowledge and treatment.