Thirty-one shoulders in eighteen cadavera were dissected to allow study
of the neurovascular anatomy of the rotator cuff and to help determine the
limits of mobilization of the cuff for the repair of chronic massive
retracted tears. The dissection demonstrated the diameter, length, and
relationships of the suprascapular nerve and its branches and made clear
the dangers of extensive mobilization and advancement of the supraspinatus
and infraspinatus muscles. The suprascapular nerve ran an oblique course
across the supraspinatus fossa, was relatively fixed on the floor of the
fossa, and was tethered underneath the transverse scapular ligament. In
twenty-six (84 per cent) of the thirty-one shoulders, there were no more
than two motor branches to the supraspinatus muscle, and the first was
always the larger of the two. In twenty-six (84 per cent) of the thirty-one
shoulders, the first motor branch originated underneath the transverse
scapular ligament or just distal to it. In one shoulder (3 per cent), the
first motor branch passed over the ligament. The average distance from the
origin of the long tendon of the biceps to the motor branches of the
supraspinatus was three centimeters. In fifteen (48 per cent) of the
thirty-one shoulders, the infraspinatus muscle had three or four motor
branches of the same size. The average distance from the posterior rim of
the glenoid to the motor branches of the infraspinatus muscle was two
centimeters. The motor branches to the supraspinatus muscle were fewer,
usually smaller, and significantly shorter than those to the infraspinatus
muscle. The standard anterosuperior approach allowed only one centimeter of
lateral advancement of either tendon and limited the ability of the surgeon
to dissect safely beyond the neurovascular pedicle. The advancement
technique of Debeyre et al., or a modification of that technique, permitted
lateral advancement of each muscle of as much as three centimeters and was
limited by tension in the motor branches of the suprascapular nerve. In
some situations, the safe limit of advancement may be even less. We
concluded that lateral advancement of the rotator cuff is limited
anatomically and may place the neurovascular structures at risk.