Shoulder – Anterior Approach

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.