Lateral Approach to the Shoulder

Lateral deltoid splitting approach with the incision lines marked on the arm
Lateral deltoid splitting approach with the incision lines marked on the arm. The deltoid is split and a muscle bridge containing the axillary nerve (yellow arrowhead) is preserved across the split. Image from Putzeys G, Nugteren LHT, Reynders-Frederix P, Hartog DD. The radial nerve bridging plate technique for humeral shaft fractures, an approach facilitating plate removal without impeding fracture union – a case series. Eur J Trauma Emerg Surg. 2026, 52(1), 295. CC BY 4.0.

Not extensile

Lateral Approach to the Shoulder, bursae around the shoulder joint
Bursae around the shoulder joint. Image by Zameer Hirji, Wikimedia Commons, CC BY 3.0.

Position

  • supine
  • Mayfield headrest
  • Beach chair 45°
  • sandbag

Landmarks

  • acromion
  • clavicle
  • spine of scapula

Incision

  • 5cm longitudinal incision
  • Start: tip of acromion
  • End: down lateral aspect of arm

Internervous Plane

  • none

Superficial Dissection

  • fat
  • deep fascia
  • split deltoid in line with fibres
  • stay suture at inferior aspect to avoid damage to axillary nerve

Deep Dissection

  • lateral aspect of upper humerus, R/C & SA bursa will be exposed

Dangers

  • axillary nerve
    • leaves posterior wall of axilla by penetrating quadrangular space
    • winds around humerus with posterior circumflex humeral arteries
    • enters deltoid posterior from its deep surface 7 cm below tip of acromion
    • nerve fibres then spread anteriorly

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.