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