Anterolateral Approach to the Shoulder

Anterolateral incision starting at the anterolateral corner of the acromion (arrow) — Anterolateral incision starting at the anterolateral corner of the acromion (arrow). The white line marks the level and course of the axillary nerve across the deltoid. Image from Alberio RL, Del Re M, Grassi FA. Minimally Invasive Plate Osteosynthesis for Proximal Humerus Fractures, A Retrospective Study Describing Principles and Advantages of the Technique. Adv Orthop. 2018, 2018, 5904028. CC BY 4.0.

Gray’s Anatomy illustration of the axillary nerve — Suprascapular and axillary nerves from behind. The axillary nerve runs about 5 cm below the acromion, which limits how far deltoid can be split. Image by Henry Vandyke Carter, Gray’s Anatomy (1918), Wikimedia Commons, public domain.

Position

supine
Mayfield headrest
Sandbag under spine & medial border of scapula
Beachchair 45°
Prep & drape limb free

Landmarks

Clavicle
Acromion
Spine of scapula
Coracoid process

Incision

Transverse incision
Start: anterolateral corner of acromion
End: just lateral of coracoid process

Internervous Plane

None
- Deltoid muscle is detached proximal to nerve supply

Superficial Dissection

Subcutaneous fat
Ligate numerous vessels
Deep fascia
Palpate AC joint
Detach fibres of deltoid from AC joint & continue laterally to expose 1cm of anterior aspect of acromion
Ligate acromial branch of coracoacromial artery
Split deltoid in line of its fibres starting at AC joint
- Extend 5cm
- Insert stay sutures at apex of split to avoid damage to axillary nerve

Deep Dissection

Detach coracoacromial ligament from acromion
You can now see supraspinatus & SA bursa
Rotate humeral head to expose different parts of R/C & long head of biceps

Dangers

Axillary nerve
- Runs transversely deep to deltoid 7cm below tip of acromion
Acromial branch of coracoacromial artery

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