Deltopectoral Approach to Shoulder

Question 1

Internervous plane

Answer 1

deltoid (axillary n)
pec major (med + lat pectoral n)

Question 2

Dangers

Answer 2

musculocutaneous n - medial side of biceps 5-8 cm distal to coracoid
axillary n - at risk with subscap release (runs distal + medial to)
ant circumflex humeral a
cephalic vein

Question 3

Indications

Answer 3

Shoulder arthorplasty
open shoulder stabilisation
proximal humerus #s
drainage of joint infection

Question 4

Position

Answer 4

supine.
sandbag under medial border of scapula
pt pulled to edge of table
beach chair position (30-45 sit up)

Question 5

Landmarks

Answer 5

coracoid process

deltopectoral groove

Question 6

Incision

Answer 6

10-15cm straight incision from tip of coracoid to deltopectoral groove

Question 7

Superficial dissection

Answer 7

thru’ subcut fat to fascia overlying pec major + deltoid.

Find fat overlying deltopectoral groove - cephalic vein running down

• retract cephalic vein laterally buzz small vessels
• blunt dissection + self-retainer

retract detoid laterally + pec medially
- expose conjoint tendon (coracobracialis, short head of biceps + pec minor)