SynthesisSurgical and radiologic anatomy : SRA2026
Anatomical relationship of the suprascapular and axillary nerves to the glenohumeral joint and its surgical significance: a systematic review.
Synthesis in Surgical and radiologic anatomy : SRA, 2026. 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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Abstract
purposeThe suprascapular (SSN) and axillary (AXN) nerves are vital for shoulder mobility and are at notable risk for injury during glenohumeral surgeries due to their proximity to key anatomical landmarks. This systematic review evaluates their anatomical positioning relative to the glenohumeral joint and highlights the clinical significance of these relationships in shoulder procedures.
methodsA thorough literature search across PubMed, MEDLINE, and Google Scholar (2018-2025) yielded 424 studies. After applying inclusion criteria, 21 articles-including clinical, cadaveric, and systematic reviews-were selected to assess nerve pathways, anatomical variations, injury rates, and surgical relevance.
resultsThe pooled incidence of SSN injury was 0.03 (95% CI: 0.00-0.08), indicating an extremely low occurrence across studies. In contrast, the pooled incidence of AXN injury was 0.07 (4%) [95% CI: 0.01-0.18], reflecting a higher but still uncommon risk. Meta-regression showed a significant association between longer follow-up duration and increased reporting of AXN injuries (p = 0.0005), whereas this relationship was not significant for SSN injuries (p = 0.3612). Significant publication bias was detected for both nerves (AXN: p = 0.0016; SSN: p < 0.0001). Overall, AXN injuries occurred in approximately 1% of cases-more frequent than SSN injuries, which were nearly absent in pooled analysis.
conclusionAnatomical variability in the SSN and AXN significantly influences the likelihood of nerve injury during shoulder surgery. Utilizing preoperative imaging, tailoring surgical approaches to individual anatomy, and employing intraoperative nerve monitoring are essential strategies for minimising nerve damage. Enhanced anatomical education-through cadaveric dissection and surgical simulation-should be emphasised to reinforce knowledge. These findings support adopting nerve-sparing, patient-specific surgical techniques to improve safety and outcomes in shoulder procedures.
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