Simultaneous musculocutaneous nerve entrapment and radial nerve traction injury after open subpectoral biceps tenodesis: a unique case demonstrating a rope-effect mechanism

Open subpectoral biceps tenodesis is a well-established treatment for long head of the biceps1 (LHB) pathology, providing reliable outcomes and low complication rates2-6. However, the musculocutaneous nerve (MCN) lies close to the subpectoral fixation site. Cadaveric studies show that arm positioning—particularly external rotation—significantly alters MCN proximity to the humerus and drill trajectory2. Most reported nerve complications are transient neuropraxias related to traction or retractor pressure6-9.