Arthroscopic Mumford Procedure Utilizing the Anteromedial and Neviaser Portals – A Pilot Cadaveric Study on Neurovascular Structures at Risk
- Author:
Nasir Mohd Nizlan
;
Azfar Rizal Ahmad
;
Hisham Abdul Rashid
;
Paisal Hussin
;
Che Hamzah Fahrudin
;
Abdullah Arifaizad
;
Mohamad Aris Moklas
- Publication Type:Journal Article
- Keywords:
Acromioclavicular joint;
Mumford procedure;
Neviaser portal;
cadaveric study
- MeSH:
urgical Procedures, Operative;
General Surgery
- From:Malaysian Journal of Medicine and Health Sciences
2016;12(2):18-22
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: Degenerative disorder involving the acromioclavicular
joint (ACJ) is quite common especially in the elderly.
One of the surgical modalities of treatment of this disorder is the
Mumford Procedure. Arthroscopic approach is preferred due to
its reduced morbidity and faster post-operative recovery. One
method utilizes the anteromedial and Neviaser portals, which
allow direct and better visualization of the ACJ from the
subacromial space. However, the dangers that may arise from
incision and insertion of instruments through these portals are
not fully understood. This cadaveric study was carried out to
investigate the dangers that can arise from utilization of these
portals and which structures are at risk during this procedure.
Materials and Methods: Arthroscopic Mumford procedures
were performed on 5 cadaver shoulders by a single surgeon
utilizing the anteromedial and Neviaser portals. After marking
each portals with methylene blue, dissection of nearby structures
were carried out immediately after each procedure was
completed. Important structures (subclavian artery as well as
brachial plexus and its branches) were identified and the nearest
measurements were made from each portal edges to these
structures. Results: The anteromedial portal was noted to be
closest to the suprascapular nerve (SSN) at 2.91 cm, while the
Neviaser portal was noted to be closest also to the SSN at 1.60
cm. The suprascapular nerve was the structure most at risk
during the Mumford procedure. The anteromedial portal was
noted to be the most risky portal to utilize compared to the
Neviaser portal. Conclusion: Extra precaution needs to be given
to the anteromedial portal while performing an arthroscopic
distal clavicle resection in view of the risk of injuring the
suprascapular nerve of the affected limb.
- Full text:P020161130315325682877.pdf
