Efficacy of a high-intensity home stretching device and traditional physical therapy in non-operative management of adhesive capsulitis - a prospective, randomized control trial.

BACKGROUND: Historically, in-person physical therapy serves as a foundational component of nonoperative treatment of adhesive capsulitis (AC). This study compares the effectiveness of an at-home high-intensity stretch (HIS) device to traditional physical therapy (PT) and to PT in combination with the HIS device. We hypothesize that the HIS device will be as effective as PT alone or as combination therapy in the first-line treatment of AC and use of the HIS device will exhibit improvement at higher rate. METHODS: Thirty-four patients with idiopathic adhesive capsulitis and a minimum of 12 months follow-up were included in this study. Patients were randomized into one of the three groups: HIS device, PT alone, or HIS device + PT. Passive range of motion (ROM), American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) scores were measured. Additionally, patient satisfaction, compliance and complications were recorded. Paired t-test, ANOVA and Chi-squared tests were used in analysis. RESULTS: Final ROM in all planes improved for all groups compared to baseline (p < 0.001), with only HIS device group able to restore > 95% of contralateral ROM in all planes at final follow-up. Patients with PT alone were on average slowest to improve ROM from baseline, at 3 months, 6 months, and 1 year in all planes except internal rotation. ASES and SST scores improved for all groups when compared to baseline (p < 0.001). Use of HIS-device resulted in greater improvement in SST and ASES Total scores compared to PT alone (p = 0.045, and p = 0.048, respectively). CONCLUSIONS: Use of an at-home high-intensity stretching device for conservative treatment of idiopathic adhesive capsulitis improves outcomes in ROM and in ASES and SST scores both when used as an adjunct to physical therapy and when used alone. TRIAL REGISTRATION: The study protocol was registered at www. CLINICALTRIALS: gov (20/05/2022, NCT05384093).

Is Edema at the Posterior Medial Tibial Plateau Indicative of a Ramp Lesion? An Examination of 307 Patients With Anterior Cruciate Ligament Reconstruction and Medial Meniscal Tears.

BACKGROUND: Medial meniscal tears are commonly seen during anterior cruciate ligament reconstruction (ACLR). A subset of these injuries includes posterior meniscocapsular junction or "ramp" tears. One criterion that may correlate with a ramp lesion is the presence of posterior medial tibial plateau (PMTP) edema. PURPOSE: To compare patients with ramp lesions to patients with nonramp (meniscal body) medial meniscal tears and correlate PMTP edema on preoperative magnetic resonance imaging (MRI) to the incidence of ramp tears. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: From 2006 to 2016, a total of 852 patients underwent ACLR and had operative reports available for review. Age, sex, laterality, mechanism of injury (contact/noncontact), sport, revision procedure, multiligament injury, time to MRI, and time to surgery were recorded. Preoperative MRI scans were reviewed for PMTP edema using axial, coronal, and sagittal T2 and proton-density sequences. Differences between groups were analyzed using a 2-sample t test and chi-square test. Univariate and multivariate logistic regression models examined correlations with tear type. RESULTS: Overall, 307 patients had medial meniscal tears identified during ACLR (127 ramp lesions, 180 meniscal body lesions). The ramp group was 7.5 years younger than the meniscal body group (P < .01). The groups were not different regarding sex, contact injury, revision surgery, laterality, or multiligament injury. Patients with delayed ACLR were significantly more likely to have a meniscal body tear than a ramp lesion (odds ratio, 3.3 [95% CI, 1.9-5.6]; P < .01). The sensitivity of PMTP edema for a ramp tear was 66.3%, and 54.5% of patients with ACLR and a medial meniscal tear had PMTP edema. Patients with PMTP edema were significantly more likely to have a ramp tear than a meniscal body tear (odds ratio, 2.1 [95% CI, 1.1-4.1]; P < .03). CONCLUSION: The overall incidence of ramp tears in patients undergoing ACLR was 14.9%, and these tears were more prevalent in younger patients. Meniscal body tears were significantly more likely than ramp tears with delayed ACLR. In patients undergoing ACLR with an associated medial meniscal tear, the presence of PMTP edema demonstrated significantly greater odds for ramp lesions compared with meniscal body tears.

Relationship Between Deltoid and Rotator Cuff Muscles During Dynamic Shoulder Abduction: A Biomechanical Study of Rotator Cuff Tear Progression.

BACKGROUND: Previous biomechanical studies regarding deltoid function during glenohumeral abduction have primarily used static testing protocols. HYPOTHESES: (1) Deltoid forces required for scapular plane abduction increase as simulated rotator cuff tears become larger, and (2) maximal abduction decreases despite increased deltoid forces. STUDY DESIGN: Controlled laboratory study. METHODS: Twelve fresh-frozen cadaveric shoulders with a mean age of 67 years (range, 64-74 years) were used. The supraspinatus and anterior, middle, and posterior deltoid tendons were attached to individual shoulder simulator actuators. Deltoid forces and maximum abduction were recorded for the following tear patterns: intact, isolated subscapularis (SSC), isolated supraspinatus (SSP), anterosuperior (SSP + SSC), posterosuperior (infraspinatus [ISP] + SSP), and massive (SSC + SSP + ISP). Optical triads tracked 3-dimensional motion during dynamic testing. Fluoroscopy and computed tomography were used to measure critical shoulder angle, acromial index, and superior humeral head migration with massive tears. Mean values for maximum glenohumeral abduction and deltoid forces were determined. Linear mixed-effects regression examined changes in motion and forces over time. Pearson product-moment correlation coefficients ( r) among deltoid forces, critical shoulder angles, and acromial indices were calculated. RESULTS: Shoulders with an intact cuff required 193.8 N (95% CI, 125.5 to 262.1) total deltoid force to achieve 79.8° (95% CI, 66.4° to 93.2°) of maximum glenohumeral abduction. Compared with native shoulders, abduction decreased after simulated SSP (-27.2%; 95% CI, -43.3% to -11.1%, P = .04), anterosuperior (-51.5%; 95% CI, -70.2% to -32.8%, P < .01), and massive (-48.4%; 95% CI, -65.2% to -31.5%, P < .01) cuff tears. Increased total deltoid forces were required for simulated anterosuperior (+108.1%; 95% CI, 68.7% to 147.5%, P < .01) and massive (+57.2%; 95% CI, 19.6% to 94.7%, P = .05) cuff tears. Anterior deltoid forces were significantly greater in anterosuperior ( P < .01) and massive ( P = .03) tears. Middle deltoid forces were greater with anterosuperior tears ( P = .03). Posterior deltoid forces were greater with anterosuperior ( P = .02) and posterosuperior ( P = .04) tears. Anterior deltoid force was negatively correlated ( r = -0.89, P = .01) with critical shoulder angle (34.3°; 95% CI, 32.0° to 36.6°). Deltoid forces had no statistical correlation with acromial index (0.55; 95% CI, 0.48 to 0.61). Superior migration was 8.3 mm (95% CI, 5.5 to 11.1 mm) during testing of massive rotator cuff tears. CONCLUSION: Shoulders with rotator cuff tears require considerable compensatory deltoid function to prevent abduction motion loss. Anterosuperior tears resulted in the largest motion loss despite the greatest increase in deltoid force. CLINICAL RELEVANCE: Rotator cuff tears place more strain on the deltoid to prevent abduction motion loss. Fatigue or injury to the deltoid may result in a precipitous decline in abduction, regardless of tear size.

Novel case of Trevor's disease: Adult onset and later recurrence.

Dysplasia epiphysealis hemimelica (DEH), or Trevor's disease, is an osteocartilaginous epiphyseal overgrowth typically occurring in children. The literature reports 6 adult cases and none describe recurrence requiring additional procedures. We present a new-onset proximal tibial DEH in an adult recurring approximately 3 years after open excision. A 39-year-old female presented with a history of right knee pain, swelling, and instability. Physical examination revealed a firm proximal tibial mass. Computed tomography (CT) imaging showed an exophytic, lobulated, sclerotic mass involving the anterolateral margin of the lateral tibial plateau. Magnetic resonance imaging was suggestive of an osteochondroma. The patient underwent curettage of the lesion due to its periarticular location. Histology revealed benign and reactive bone and cartilage consistent with periosteal chondroma. Two and a half years later, the patient presented with a firm, palpable mass larger than the initial lesion. CT revealed a lateral tibial plateau sclerotic mass consistent with recurrent intra-articular DEH. A complete excision was performed and histology showed sclerotic bone with overlying cartilage consistent with exostosis. DEH is a rare epiphyseal osteocartilaginous outgrowth frequently occurring in the long bones of children less than 8 years old. DEH resembles an osteochondroma due to its pediatric presentation and similar histologic appearance. Adult-onset cases comprise less than 1% of reported cases. Recurrence rate after surgical intervention is unknown. Only 1 such case, occurring in a child, has been described. Clinicians contemplating operative treatment for DEH should note the potential for recurrence and consider complete excision. A follow-up period of several years may be warranted to identify recurrent lesions.

Anatomic Repair of Posteromedial Meniscocapsular Separation Using an All-Inside Technique.

Separation of the posteromedial meniscocapsular junction (PMC) is a unique injury seen in patients with disruption of the anterior cruciate ligament. PMC tears may go unrecognized despite preoperative magnetic resonance imaging and diagnostic arthroscopy of the medial compartment. Unrepaired lesions may lead to persistent laxity of the knee after anterior cruciate ligament reconstruction. Inside-out repair techniques risk iatrogenic injury to the articular cartilage during needle passage and require dissection of the posteromedial knee for suture retrieval. Previous all-inside techniques have required specialized implants and repaired PMC lesions with direct visualization of the tear. The presented all-inside technique is an easily reproducible, cost-effective means to anatomically repair separation of the PMC. The technique provides the surgeon direct visualization and full arthroscopic access to the lesion, making repair technically easy and efficient.

Does Knowledge of Implant Cost Affect Fixation Method Choice in the Management of Stable Intertrochanteric Hip Fractures?

We conducted a study to determine if knowledge of implant cost affects fixation method choice in the management of stable intertrochanteric hip fractures. We retrospectively reviewed the cases of 119 patients treated with a sliding hip screw (SHS; Versafix), a short Gamma nail (SGN), or a long Gamma nail (LGN). Of the 119 fractures, 71 were treated before implant costs were revealed, and 48 afterward. The 2 groups were similar in age, sex, fracture types, American Society of Anesthesiologists physical status classification, and preinjury ambulatory status. SHS was used in 38.0% of the before cases and 27.1% of the after cases, SGN in 29.6% of the before cases and 45.8% of the after cases, and LGN in 32.4% of the before cases and 27.1% of the after cases. Changes in implant use were not statistically significant. SHS was favored for 31-A1.1, 31-A1.2, and 31-A2.1 fractures in the before group but only for 31-A1.2 fractures in the after group. Gamma nails of both sizes were preferred in the after group for 31-A1.1, 31-A1.3, and 31-A2.1 fractures. At our institution, surgeon knowledge of implant cost did not affect fixation method choice in the management of stable intertrochanteric hip fractures.

Mini-Medical School Programs' Influence on Students' Desire to Pursue Medicine.

PURPOSE: Mini-Medical school programs have become an increasingly popular means of encouraging high-school students to consider medical professions. However, there is little research evaluating the long-term effect of these programs on influencing career choice. The purpose of our study was to determine the motivational factors for attending the Mini-Medical school programs at our institution, student satisfaction with their experience, and whether it impacts intended secondary education and career choices. METHODS: An online anonymous survey was distributed to Drexel University College of Medicine Mini-Medical school program graduates to determine factors influencing student participation and program satisfaction. RESULTS: The most influential factors in attending the program were to confirm an interest in medicine (n = 55, 95%) and parental advice (n = 29, 50%). Most maintained an interest in medicine: 57% (n = 33) pursued a pre-med degree, 55% (n = 32) planned to apply to medical school within 3 years; and 12% (n = 7) were either in medical school or matriculating in the fall of 2015. 91% (n = 53) participants noted the program's influence on choosing a pre-med undergraduate track. CONCLUSION: Our results suggest Mini-Medical school programs significantly impacted students' decision to pursue a medical career through fostering interest and effectively answering students' questions about the field.

Medial epicondylitis: evaluation and management.

Medial epicondylitis, often referred to as "golfer's elbow," is a common pathology. Flexor-pronator tendon degeneration occurs with repetitive forced wrist extension and forearm supination during activities involving wrist flexion and forearm pronation. A staged process of pathologic change in the tendon can result in structural breakdown and irreparable fibrosis or calcification. Patients typically report persistent medial-sided elbow pain that is exacerbated by daily activities. Athletes may be particularly symptomatic during the late cocking or early acceleration phases of the throwing motion. Nonsurgical supportive care includes activity modification, NSAIDs, and corticosteroid injections. Once the acute symptomology is alleviated, focus is turned to flexor-pronator mass rehabilitation and injury prevention. Surgical treatment via open techniques is typically reserved for patients with persistent symptoms.

Degenerative meniscus: Pathogenesis, diagnosis, and treatment options.

The symptomatic degenerative meniscus continues to be a source of discomfort for a significant number of patients. With vascular penetration of less than one-third of the adult meniscus, healing potential in the setting of chronic degeneration remains low. Continued hoop and shear stresses upon the degenerative meniscus results in gross failure, often in the form of complex tears in the posterior horn and midbody. Patient history and physical examination are critical to determine the true source of pain, particularly with the significant incidence of simultaneous articular pathology. Joint line tenderness, a positive McMurray test, and mechanical catching or locking can be highly suggestive of a meniscal source of knee pain and dysfunction. Radiographs and magnetic resonance imaging are frequently utilized to examine for osteoarthritis and to verify the presence of meniscal tears, in addition to ruling out other sources of pain. Non-operative therapy focused on non-steroidal anti-inflammatory drugs and physical therapy may be able to provide pain relief as well as improve mechanical function of the knee joint. For patients refractory to conservative therapy, arthroscopic partial meniscectomy can provide short-term gains regarding pain relief, especially when combined with an effective, regular physiotherapy program. Patients with clear mechanical symptoms and meniscal pathology may benefit from arthroscopic partial meniscectomy, but surgery is not a guaranteed success, especially with concomitant articular pathology. Ultimately, the long-term outcomes of either treatment arm provide similar results for most patients. Further study is needed regarding the short and long-term outcomes regarding conservative and surgical therapy, with a particular focus on the economic impact of treatment as well.

On-field performance of national football league players after return from concussion.

BACKGROUND: There are few data examining the short-term effects of concussions on player performance upon return to play. This study examined changes in on-field performance and the influence of epidemiologic factors on performance and return to play. HYPOTHESIS: On-field performance is different in players who return within 7 days after concussion compared with players who miss at least 1 game. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Players in the National Football League who were active during the 2008 to 2012 seasons were considered for inclusion. Weekly injury reports identified concussed players. All players played in at least 4 games before and after the game of injury (sentinel game) within the year of injury (sentinel year). Players who had missed games secondary to another injury or had sustained a second concussion within the sentinel year were excluded. The players' league profiles were used to determine age, position, body mass index, career experience, and games missed. ProFootballFocus performance scores determined player ratings. Statistical analysis used 2-sided t tests and both univariate and multivariate logistic regression models. RESULTS: There were a total of 131 concussions in the 124 players who qualified for this study; 55% of these players missed no games. Defensive secondary, wide receiver, and offensive line were the most commonly affected positions. Players who missed at least 1 game were younger and less experienced. Preinjury ProFootballFocus performance scores were similar to postinjury performance in players without games missed (0.16 vs 0.33; P = .129) and players who missed at least 1 game (-0.06 vs 0.10; P = .219). Age, body mass index, experience, and previous concussion did not correlate with changes in postinjury scores (P > .05). Older, more experienced players and players with late-season concussions were more likely to return to play without missing games (P < .05). The odds of returning within 7 days increased by 18% for each career year and by 40% for each game before the sentinel game within the sentinel year; these same odds decreased by 85% after introduction of newer treatment guidelines in 2009. CONCLUSION: No difference in player performance after concussion was found whether the player did or did not miss games before return. Return without missing games may be associated with experience and timing of injury within a season and less likely after newer guidelines.

Subacute superior patellar pole sleeve fracture.

Patellar fractures are uncommon, representing 1% of pediatric fractures. Most of these injuries are sleeve avulsions of the inferior pole. Sleeve avulsion of the superior pole is rare, with only 14 cases reported in the English-language literature. These injuries occur in adolescents after forced knee flexion or direct anterior blow. Radiographs may reveal patella baja, anterior tilt, and suprapatellar calcifications. Ultrasound and magnetic resonance imaging (MRI) can confirm the diagnosis. We present a subacute superior pole sleeve fracture in a 15-year-old boy who sustained a left knee injury. Initial radiographs were negative. Ten days later, the patient returned with hemarthrosis and suprapatellar calcification. MRIs were read as "distal quadriceps tendon tear." Twenty-three days after the injury, the patient presented with a limp, palpable quadriceps tendon gap, and inability to maintain a straight leg raise. A superior pole sleeve fracture was repaired surgically the following day. An understanding of the injury demographics and radiological findings associated with superior pole sleeve fractures can prevent missed diagnosis of a rare injury. We review the literature for injury demographics, operative and nonoperative treatment methods, and outcomes.

Is formal decompression necessary for parameniscal cysts associated with meniscal tears?

BACKGROUND: Meniscal tears and associated parameniscal cysts have good outcomes after partial meniscectomy and cyst evacuation. Good outcomes have been noted after partial meniscectomy with recurrent cysts. This investigation asks if partial meniscectomy without meniscal cyst decompression is sufficient for positive patient outcome. METHODS: Sixteen patients treated between 2005 and 2010 for a meniscal cyst and concomitant meniscal tear. Inclusion criteria were meniscal tear and parameniscal cyst per MRI, no prior surgery on the affected knee, and Outerbridge classification of I/II. Two patients were excluded. Fourteen patients completed the study until final follow-up. Lysholm knee scores were documented at 6 months post-operatively and at final follow-up. Re-evaluation or second surgery of the treated knee was documented. RESULTS: Eight lateral cysts and six medial cysts were diagnosed. Eight cysts were associated with a horizontal cleavage tear, while six menisci had a complex tear with a horizontal cleavage component. The average cyst size was 1.3 cm (0.5 to 3.5) at the largest diameter. At 6 months, the average Lysholm knee score was 94.1. At mean 5 years, the average score was 89.1. Patients with medial cysts, cysts greater than 1.0 cm, horizontal cleavage tears, or without simultaneous chondroplasty scored higher in the short and medium-term than their respective counterparts. CONCLUSIONS: Excellent short and medium-term outcomes can be achieved following partial meniscectomy without cyst decompression for patients with meniscal cysts and associated meniscal tears. LEVEL OF EVIDENCE: Level IV.

Diagnosis and treatment of triceps tendon injuries: a review of the literature.

OBJECTIVE: To elucidate mechanism of injury, nonoperative protocols, surgical techniques, rehabilitation schedules, and return to sports guidelines for partial and complete triceps tendon injuries. DATA SOURCES: The PubMed and OVID databases were searched in 2010 and peer-reviewed English language articles in 2011. MAIN RESULTS: After a fall on an outstretched hand, direct trauma on the elbow, or lifting against resistance, patients often present with pain and weakness of extension. Examination may reveal a palpable tendon gap, and radiographs may reveal a Flake sign. Acute partial injuries have positive outcomes with immobilization in 30-degree flexion for 4 to 6 weeks. Primary repair for complete rupture can restore normal extensor function after 3 to 4 months. Reconstruction returns normal extensor function up to 4 years. Most authors support postoperative immobilization for 2 to 3 weeks at 30- to 40-degree flexion, flexion block bracing for an additional 3 weeks, and unrestricted activity at 6 months. Athletes may be able to return to sports after 4 to 5 weeks of recovery from a partial injury, but return may be delayed if operative tendon repair is performed. CONCLUSIONS: Acute partial triceps tendon injuries may be managed conservatively at first and should be repaired primarily if this fails or if presentation is delayed. Reconstruction should first use the anconeus rotation technique. If the anconeus is devitalized, the Achilles tendon may be the allograft of choice.

How should unmatched orthopaedic surgery applicants proceed?

BACKGROUND: Obtaining an orthopaedic surgery residency is competitive. Advisors must understand what factors may help unmatched candidates reapply successfully. QUESTIONS/PURPOSES: We determined (1) the attitude of leaders of orthopaedic surgery residency programs toward interviewing unmatched students; (2) whether a surgical internship or a research year is preferred in considering reapplicants; (3) the importance of United States Medical Licensing Examination (USMLE) scores, recommendations, and Alpha Omega Alpha (AOA) membership; and (4) whether academic and nonacademic programs evaluate reapplicants differently. METHODS: We sent an anonymous 19-question survey to 151 Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic surgery residency programs in five waves, 1 week apart (December 5, 2009-January 5, 2010). Investigators were blinded to the respondents' identities. RESULTS: Ninety-one of the 151 programs (60%) responded. Sixty-eight of the 91 programs (75%) stated they rarely accept unmatched applicants. Sixty-eight programs (75%) agreed an unmatched applicant should do a surgery internship for 1 year. Of the 36 programs that recommended a research year, 32 were academic programs. Academic programs were more likely than nonacademic programs to view as important new recommendations (85% versus 67%), minimum scores of 220 on Step I (67% versus 49%) and Step II (64% versus 36%), and AOA membership (85% versus 67%). CONCLUSIONS: By completing a surgical internship, unmatched students may increase their chances of matching. Students considering academic programs should ensure their academic record meets certain benchmarks and may consider a research year but risk limiting their acceptance to academic programs.

Does lateral release change patellofemoral forces and pressures?: a pilot study.

BACKGROUND: One complication of TKA is postoperative anterior knee pain. Balancing retinacular tissue tension to improve patellar tracking is essential in preventing pain. Lateral release might help balance tension although the quantitative changes in patellofemoral force and pressure differentials after lateral release are unknown. QUESTIONS/PURPOSES: We asked if there are differences in patellofemoral forces and pressures for knees resurfaced with standard and gender-specific components and whether lateral release changes these differentials. METHODS: We studied six fresh-frozen cadaver knees with native knees and knees that had TKAs with patellofemoral resurfacing using traditional and gender-specific components. The knees were taken through passive ROM, and the means for medial and lateral peak pressure and maximum force were calculated before and after a lateral release was performed. RESULTS: In traditional resurfaced knees, lateral peak pressure was greater than medial peak pressure by 727.6 ± 550.0 kPa and lateral maximum force was greater than medial maximum force by 29.6 ± 15.9 N. Lateral release decreased the pressure (71.4 ± 826.0 kPa) and force (10.0 ± 32.1 N) differentials in the traditional but not in the gender-specific design. In gender-specific resurfaced knees, lateral peak pressure was greater than medial peak pressure by 158.7 ± 360.0 kPa and lateral maximum force was greater than medial maximum force by 15.5 ± 10.4 N. Lateral release increased the pressure (285.7 ± 565.0 kPa) and force (16.8 ± 10.8 N) differentials. CONCLUSIONS: Our preliminary data suggest lateral release is more effective in reducing peak pressure and maximum force differentials in knees resurfaced with traditional standard components than with gender-specific components. CLINICAL RELEVANCE: The lateral release technique might help with tissue balancing when using standard components in TKA.

Anatomical considerations of subcoracoid neurovascular structures in anterior shoulder reconstruction.

Anterior shoulder surgery, using open or arthroscopic technique, places subcoracoid neurovasculature at risk. This study examines the relationships of the brachial plexus and axillary artery to four bony landmarks and provides clinical correlations for anterior shoulder surgery. The musculocutaneous nerve (MN), posterior cord (PC), lateral cord (LC), and axillary artery (AA) were identified in 27 shoulders. Minimum distances (mm) were measured between neurovasculature and the coracoid tip, anterior midglenoid, inferior surface of the midclavicle, and anteromedial aspect of the acromioclavicular joint. Average distances from the coracoid to the MN, PC, LC, and AA were 69.7 ± 31.6, 50.5 ± 9.2, 41.8 ± 9.4, and 60.0 ± 8.0 mm, respectively; from the glenoid equator to the MN, PC, LC, and AA were 61.5 ± 38.5, 37.0 ± 6.1, 35.2 ± 8.7, and 45.2 ± 7.1 mm, respectively; from the midclavicle to the MN, PC, LC, and AA were 114.1 ± 33.9, 62.0 ± 13.6, 56.0 ± 19.7, and 69.9 ± 7.8 mm, respectively; and from the AC joint to the MN, PC, LC, and AA were 112.7 ± 36.5, 87.9 ± 10.6, 84.0 ± 12.0, and 100.9 ± 1.0 mm, respectively. The lateral cord was the closest structure to each bony landmark. The musculocutaneous nerve was the furthest structure from each bony landmark. Open procedures using a deltopectoral approach with the shoulder in the anatomical position, such as the Neer capsular shift and Warner capsular reconstruction, can use these results to prevent direct or retraction injuries. Results indicate a potential safe zone of 30 mm in diameter around the anteromedial coracoid tip for anteroinferior portal placement.