Introduction
Overview
- This approach is infrequently used
- This approach offers access to the posterior and inferior aspects of the shoulder
Indications
- Proximal humerus fracture-dislocations
- Glenoid fractures/osteotomy
- Removal loose bodies
- Irrigation and debridement of septic joint
- Scapular neck fractures
Internervous plane
- Teres minor (axillary n.)
- Infraspinatus (suprascapular n.)
Preparation
Anesthesia
- General anesthetic
Table
- Radiolucent flat-top table
Patient Position
- Prone is most common
- Lateral
- Beach-chair
Approach
Incision
- The patient is positioned in the lateral decubitus position with the ipsilateral arm draped free
- The incision is made along the scapular spine, extending to the lateral acromial border
Superficial dissection
- Attention must be paid to superficial skin vessels, as these can bleed significantly
- The origin of the deltoid is released from the scapular spine
- The plane between the deltoid and infraspinatus is encountered and bluntly developed
- This is typically easiest to find at the lateral aspect of the incision
- The deltoid is retracted distally/laterally
Deep dissection
- The interval between the infraspinatus (suprascapular nerve) and teres minor (axillary nerve) is bluntly developed
- This is often difficult to find, but should be done carefully
- Retract the infraspinatus superiorly and the teres minor inferiorly to expose the posterior glenoid and scapular neck
Danger
Suprascapular nerve
- Passes around the base of the scapular spine (do not retract infraspinatus too vigorously)
Axillary nerve
- Runs through the quadrangular space beneath the teres minor (stay superior to the teres minor)
- This is accompanied by the posterior circumflex humeral artery
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