Anterior approach to the humerus

Thompson, Henry

Aims

to approach the anterior aspect of the humerus

Principles

2 internervous planes
- proximally
  - deltoid / pect major
- distally
  - brachialis split

Position

supine
arm on arm board
prep & drape arm free

Landmarks

coracoid
long head of biceps

Incision

Longitudinal incision along deltopectoral groove & lateral border of biceps
Start:
- Coracoid process

Internervous Plane

Proximally
- Deltoid muscle
  - Axillary nerve
- Pectoralis muscle
  - Axillary nerve
Distally
- Brachialis split
  - Musculocutaneous nerve (medially)
  - Radial nerve (laterally)

Superficial Dissection

Proximal
- Develop the plane of deltopectoral groove & take cephalic vein laterally
- Deltoid tuberosity & lateral lip of bicipital groove
Distal
- Develop interval between biceps & brachialis
- Retract biceps medially

Deep Dissection

Proximal
- Incise periosteum lateral to insertion of pectoralis major
- Continue proximally, staying lateral to biceps tendon
- Ligate anterior circumflex humeral artery
- If needed
  - Dissect subperiosteally
    - Insertion of pect major
    - Subscapularis
Distal
- Split fibres of brachialis longitudinally
- Subperiosteal dissection
- Strip brachialis off anterior surface of bone

Dangers

Nerve
- Radial
- Axillary nerve
Vessels
- Anterior humeral circumflex