Posterior Approach to the Shoulder

Posterior approach to the shoulder and scapula through an incision from the acromion towards the inferior angle of the scapula
Posterior approach to the shoulder and scapula through an incision from the acromion towards the inferior angle of the scapula. After exposing the posterior deltoid, the deep interval between infraspinatus and teres minor is developed. Image from Jessen M, Albers S, Zehnder P, Zyskowski M, Biberthaler P, Kirchhoff C, Schwarz M. Osteosynthesis using a Brodsky approach after scapular fractures, good clinical results after a mean follow-up of 6.3 years. J Orthop Surg Res. 2026, 21(1), 154. CC BY 4.0.
Gray’s Anatomy illustration of the posterior shoulder spaces
Muscles of the back of the shoulder, marking the quadrangular space (QS), triangular space (TS) and triangular interval (TI). The axillary nerve passes through the quadrangular space. Image by Henry Vandyke Carter, Gray’s Anatomy (1918), Wikimedia Commons, public domain.

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

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

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