Approaches of shoulder

1. Kholoud Al Fouzan
R2

2. Uses:
 Reconstruction of recurrent
dislocations
 Draining of sepsis
 Biopsy and excision of tumors
 Repair and stabilization of the tendon
of the long head of biceps
 Shoulder arthroplasties
 ORIF of fractures of proximal humerus

3.  Supine position
 Sand bag under the spine
 Head elevation 30 to 40 degree
 Proper padding

4.  Coracoid process
 Deltopectoral Groove
 Incision:
Just above the coracoid process make make a
straight incision following the line of thhe
deltopectoral groove

5.  Axillary nerve ( deltoid muscle) and medial
and lateral pectoral nerves (pectoralis major
muscle).

6.  Retract deltoid muscle laterally and
pectoralis major medially and cephalic vein to
be retracted either medially or laterally

7.  Dissect the facia
 Retract short head of biceps and coracobrachialis
medially
 In needed: detach the tip of the coracoid process
with predrilling to detach the conjoint tendon
 The arm should be kept in adducted position to
protect the axillary sheath
 Externally rotate the arm to stretch subscapularis
muscle and devide it 1 in. from its insersion after
putting stay suturs
 Incise the capsule

8.  musculocutaneous nerve
 Cephalic vein

9.  Uses:
 Recurrent posterior dislocation
 Glenoid osteotomy
 Biopsy and excision of tumors
 Removal of loose bodies posteriorly
 Draining of sepsis
 Fracture fixation

10.  Lateral position
 affected side uppermost

11.  Acromion
 spine of the scapula
 Incision:
Linear incision along the length of the scapular
spine

12. Axillary nerve (teres minor muscle) and
suprascapular nerve (infraspinatus muscle)

13.  Detach deltoid muscle from its origin

14.  Blunt dissection between infraspinatus and
teres minor
 retract infraspinatus superiorly and teres
minor inferiorly
 Incise the capsule

15.  Axillary nerve
 Suprascapular nerve
 Posterior circumflex humeral artery

16.  Uses:
 ORIF of fractures of greater tubrcle and
humeral neck
 Removal of depositis from subacromial bursa
 Repair of the rotator cuff

17.  Supine position
 Head elevation 30 to 40 degrees

18.  Acromion
 Incision:
Longtudinal incision from the tip of the
acromion down the lateral aspect of the arm

19.  No true internervous plane
 Superficial surgical dissection:
Split deltoid muscle in the line of its fibers
Insert a sutur at the inferior apex to prevent
accidental extending

20.  Incise the subacromial bursa to provide
access to the upper lateral portion of the
head of the humerus

21.  Axillary nerve

22.  Uses:
 Anterior decompression of the shoulder
 Repair of the rotator cuff
 Repair and stabilization of the long head of a
biceps tendon
 Excision of osteophytes from the
acromioclavicular joint

23.  Supine position
 Head elevation 45 degree

24.  Coracoid Process
 Acromion
 Incision:
Transverese incision from the anterolateral
corner of the acromion to the coracoid
process

25.  No true internervous plane
 Superficial surgical dissection:
Dissect the subcutaneous fat and deep facia
Coagulate the small blood vessels
Detach the fibers of the deltoid that arise
from the acromioclavicular joint by sharp
dissection

26.  Detach the coracoacromial ligament from the
acromion
 Dangers:
 Axillary nerve
 Acromial branch of the coracoacromial artery