OrthoNet

Shoulder - anterior approach

• position:
- supine
- sandbag beneath spine & med border of scapula
- elevate HOB 30-45 deg
- drape arm free

• landmarks:
- coracoid process
-deltopectoral groove

• incision:
- anterior
10-15cm along deltopectoral groove beginning just above coracoid
- axillary
adduct shoulder to 90 deg & ER
vertical incision 8-10cm long
midpoint of ant. axillary fold - extend post. axilla

• internervous plane:
- deltoid (axillary) & pec. major (med. & lat. pectoral)

• superficial dissection:
- deltopectoral groove with cephalic v
- retract pec. major med.
- retract deltoid lat. with vein

• deep dissection:
- retract SHB & CB (musculocutaneous n.) med.
- keep arm add. - keeps nv bundle loose & away from field
- divide fascia lat. to CB
- ER arm to stretch subscap. - increase distance btw subscap. & axillary n.
- sm. vessels along inf. border of subscap.
- divide subscap. 1 inch from insertion into LT
- incise jt. capsule longitudinally

• dangers:
- musculocutaneous n. - enters CB 5-8 cm below coracoid process
enters on med. side of CB
don’t retract inf.
- cephalic v.
- axillary n. - runs close to inf. border of subscap.