The lower subscapular nerve arises from the posterior cord (C5-C6) and supplies the lower subscapularis and teres major. It is the larger of the two subscapular nerves and its teres major innervation distinguishes it from the upper subscapular nerve.
Lower subscapular nerve injury produces weakness of internal rotation and shoulder adduction (teres major). Combined upper and lower subscapular nerve palsy results in complete subscapularis and teres major denervation. The lower subscapular nerve is at risk during posterior axillary dissection and subscapularis tenotomy for shoulder arthroplasty.
Weakness of internal rotation and shoulder adduction from teres major denervation, occurring in posterior cord injuries or during extensive axillary dissection for cancer surgery.
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