Distance of the radial nerve from distal interlocking screws in long-stem reverse shoulder arthroplasty: a cadaveric analysis.

Ethan R Harris, Steve S Li, Seyedeh Zahra Mousavi, Prasenjit Saha, Mark A Haft, Miriam D Weisberg-Tannenbaum, Umasuthan Srikumaran

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Article in JSES international, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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7 authors.

Ethan R HarrisDivision of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Steve S LiDivision of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Seyedeh Zahra MousaviDivision of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Prasenjit SahaDivision of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Mark A HaftDivision of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Miriam D Weisberg-TannenbaumDivision of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Umasuthan SrikumaranDivision of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Long-stem reverse total shoulder arthroplasty (rTSA) with interlocking screws is indicated for trauma and revision shoulder arthroplasty and enables fixation of the prosthesis without cement or a plate while maintaining rotational stability. We investigated the distance of the radial nerve from the distal interlocking screws of the long-stem rTSA to recommend a safe approach in placement of this prosthesis. The 3 distal 4.5-mm cortical interlocking screws of a 200-mm long-stem rTSA (FX Shoulder) were inserted with the humeral prosthesis at 0° and 20° of retroversion in 8 cadaveric specimens. A curvilinear incision from the anterolateral cubital fossa extending superolaterally along the humerus was made to expose the radial nerve between the brachialis and brachioradialis. The shortest distance from each screw to the radial nerve at 90° of elbow flexion was measured, and mean and standard deviations were calculated. At 0° of retroversion of the humeral prosthesis, the most distal 3 screws were a mean 9.5, 4.2, and 0.93 mm away from the radial nerve, respectively, whereas 20° of retroversion yielded mean screw-to-radial-nerve distances of 20, 15, and 8.7 mm, respectively. The mean distance to the radial nerve increased with increasing retroversion of the stem. We recommend using at least 20° of retroversion and making an incision anteriorly with careful retraction of soft tissues posteriorly on the humeral shaft to enable direct visualization during placement of the most distal interlocking screws to protect neurovascular structures.

Indexed as

Cadaveric studyHumeral interlocking screwsLong-stem shoulder prosthesisPeriprosthetic fractureRadial nerveRetroversionReverse shoulder arthroplasty

Identifiers

PMID40959015

DOI10.1016/j.jseint.2025.03.013

PMCPMC12435028

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