Posterior approach to the Shoulder

Position

  • Lateral
  • arm draped free

Landmarks

  • Acromion & spine of scapula

Incision

  • Along the line of the spine of the scapula to the lateral border of acromion
  • medial end can be curved distally to enhance the exposure
  • resultant scar is broad but the incision provides good exposure

Internervous plane

  • Between infraspinatus (suprascapular nerve) & teres minor (axillary nerve)

Superficial dissection

  • Can either strip deltoid off the spine of the scapula (leave a cuff to allow repair) or split deltoid in the line of its fibres over the posterior aspect of the shoulder joint

Deep surgical dissection

  • Develop a plane between the infraspinatus & teres minor
  • fibres of infraspinatus are multipennate; the fibres of teres minor are parallel
  • axillary nerve branch to teres minor enters it on the inferior aspect.
  • shoulder capsule is then on view, & can be opened

Dangers

  • axillary nerve
    • runs beneath teres minor, so make sure that the correct interval for dissection is identified
  • posterior circumflex humeral vessel
    • runs in this plane as well
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