A cadaveric assessment of the risk of nerve injury during open subpectoral biceps tenodesis using a bicortical guidewire.

Purpose: To evaluate the risk of neurological injury from the placement of a bicortical guidewire during subpectoral biceps tenodesis.

Methods: Ten forequarter cadaver specimens were evaluated. A bicortical guidewire was placed, and measurements to important local neurological structures were made with digital calipers at open dissection.

Results: The mean (range, SD) distances from the guidewire to the respective nerves was as follows: axillary nerve posteriorly, 15.7 mm (10-22 mm, 3.4); axillary nerve laterally, 18.7 mm (12-27 mm, 4.3); radial nerve posteriorly, 26.2 mm (16-35 mm, 7.0); radial nerve medially, 25 mm (16-33 mm, 4.4); and musculocutaneous nerve, 20.1 mm (12-26 mm, 5.2).

Conclusions: There has been some disagreement in the literature regarding the proximity of a bicortical guidewire to the axillary nerve posteriorly. The results of this study concur with reports from several other authors and demonstrate that this nerve is at risk of iatrogenic injury when using this technique. The clinical relevance of this work is to allow surgeons to better understand the proximity of the nerve to a bicortical guidewire and to highlight that this risk is avoided with a unicortical technique.