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Singh R.A., Ahmed B., Hay B.A., *Hay S.M.
Techniques in Shoulder and Elbow Surgery, December 2014, vol./is. 15/4(130-133)
The subscapularis splitting technique has become a very common approach for the open management of shoulder instability, including repair of Bankart lesions, capsular shift procedures, and the increasingly popular Latarjet procedure. It is often used for young athletes, as the attachment and the length of subscapularis are preserved while other open approaches may result in restricted rotation of the shoulder, particularly external rotation. The current literature reports that routine exposure of the axillary nerve is not necessary during anterior stabilization procedures using a subscapularis muscle-splitting approach if proper precautions are taken to protect the nerve. We present a case in which the axillary nerve was fortuitously noted to be coursing in an abnormally lateral position anterior to the subscapularis belly exposing the nerve at risk during subscapularis split. Our case clearly represents an important anatomic variant which must be considered when performing the subscapularis splitting approach, as serious and functional deficits will result if the nerve is irrevocably damaged. Beware the aberrant axillary nerve.
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