Shoulder Anterolateral Approach

Introduction

• Overview
  • Not frequently used due to the development of arthroscopy
  • Provides exposure to the coracoacromial ligament and supraspinatus tendon
• Indications
  • Rotator cuff repair
  • Repair of the long head of the biceps
  • Acromioclavicular joint decompression
  • Anterior shoulder decompression

Internervous plane & Applied Anatomy

• Internervous plane
  • None (deltoid split proximally to the axillary nerve)
• Applied anatomy
  • The deltoid is difficult to repair back to the acromion; limited detachment is recommended.

  
Preparation

• Anesthesia
  • general
  • brachial plexus block (interscalene)
• Position
  • beach chair
• Tourniquet
  • none

Approach

• Incision
  • An incision is made along the anterolateral edge of the shoulder, generally starting at the coracoid.
  
  
  
  
  
• Superficial dissection
  • The superficial fascia is encountered and incised
  • Superficial vessels are numerous; attention must be paid to these to facilitate visualization
  • The deltoid is then sharply released from the acromion or clavicle, depending on area of surgical need
    • This should be limited, as deltoid repair is often difficult
  • The acromial branch of the thoracoacromial artery must be ligated when encountered deep to the deltoid, near the acromioclavicular joint   
  • 
•  Deep dissection
  • The coracoacromial ligament is then released from the acromion
    • The ligament can be excised by releasing it from the coracoid as well
  • The subacromial bursa is now seen and can be excised to reveal rotator cuff pathology

Dangers

• Axillary nerve 
  • This nerve runs transversely across the surface of the deltoid muscle approximately 7 cm distal to the acromion
• Acromial branch of the thoracoacromial artery
  • Runs directly under the deltoid muscle
  
  
  

Shoulder Anterolateral Approach 2017-04-09T03:24:00-07:00 Rating: 4.5 Diposkan Oleh: Unknown