Deltopectoral Approach to the Shoulder

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Lennard Funk Manchester

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Utility Approach

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Suitable for:

1.  Arthroplasty 2.  Anterior Stabilisation procedures 3.  Proximal Humeral Fractures 4.  Glenoid Fractures 5.  Combined procedures

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Not Suitable for:

1.  Rotator Cuff Surgery 2.  Posterior Stabilisations 3.  AC Joint

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Advantages

•  Potential for extension •  Exposure •  Little bleeding (betw. Muscle planes) •  Internervous plane

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Disadvantages

•  Difficulty exposing glenoid •  Access to greater tuberosity & Cuff

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Preparation

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Instruments

•  Retractors – Norfolk-Norwich – Richards – Gelpi – Kolbel

•  Humeral Head Retractors – Fukuda – Skid

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Position Head & Neck Secured

Knees bent 30 degrees Scapula Wedge

Arm free

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Incision

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Cephalic vein

Radkowski et al. An Anatomic Study of the Cephalic Vein in the Deltopectoral Shoulder Approach. CORR. 442:139-142, January 2006.

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Coracoid is the ‘lighthouse’ to the shoulder

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Subdeltoid & Subpectoral Spaces

thoracoacromial artery

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Clavipectoral Fascia

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Axillary & Musculocutaneous Nerves

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Musculocutaneous Nerve

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Anterior Circumflex

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Subscapularis

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Anterior Capsule

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Extensions

•  Inferior: – pec major release – Medial deltoid from clavicle superiorly

•  Superior: – Detach Deltoid from acromion – Clavicle osteotomy

•  Medial – Conjoined tendon release

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Pec major & Conjoined Tendon Releases

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Clavicle Osteotomy

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Clavicular Osteotomy

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Combined Approach

Levy et al. JSES 1999

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THANK YOU

Images courtesy of: –  Operative Shoulder Surgery – Copeland –  Primal Pictures –  Lars Neumann, Nottingham

Presentation published in the Education Section at www.shoulderdoc.co.uk

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Deltopectoral Approach to the Shoulder

Documents

Transcript of Deltopectoral Approach to the Shoulder

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Operative Technique - University of Washingtonfaculty.washington.edu/alexbert/Shoulder/Surgery/... · Step 2a: Deltopectoral Approach An anterior deltopectoral incision is made beginning