The safe side and the suicide of the coracoid.

Characterization of an anatomic safe zone surrounding the lower subscapular nerve during an open deltopectoral approach

These authors dissected 12 human shoulders (6 cadavers) to describe innervation patterns of the subscapularis and to characterize a safe zone when conducting an anterior surgical approach.

The anatomic safe zone of the subscapular nerves medial to the conjoint tendon is less than 32 mm.

Their diagram of the upper (D) and lower (E) nerves to the subscapularis is shown here

 Comment: In performing the deltopectoral approach to the shoulder, we avoid any dissection medial to the lateral border of the coracoid muscles out of concern for the neurovascular structures there. This approach is graphically illustrated in the well known diagram by Steven Lippitt, shown below.

In almost all cases we find that the subscapularis can be well released by dissection lateral to the lateral border of the coracoid muscles...

and by a 360 degree release from the coracoid (A below) and the capsule (B below)

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