Lateral Approach to the Shoulder

Question 1

Indications

Answer 1

rotator cuff repair

ORIF proximal humerus #

Shoulder replacement

Question 2

Position

Answer 2

Supine, sandbag under shoulder, affected arm @ edge of table

Beach chair, sandbag under medial border of scapula, head + hand rest

Question 3

Landmarks

Answer 3

Acromion

Question 4

Internervous Plane

Answer 4

None - splitting deltoid

Question 5

Superficial dissection

Answer 5

Split deltoid - down 5cm from tip of acromion

STAY SUTURE @ distal end

find raphe between ant + middle 1/3rd of deltoid

retract deltoid anteriorly + posteriorly - reveal subdeltoid portion of subacromial bursa

Question 6

Deep dissection

Answer 6

pit subacromial bursa longitudinally - reveal lateral humerus

rotation/abducting arm brings different parts into view

Question 7

Extensions

Answer 7

Superiorly + medially across acromion + parallel to upper margin of spine of scapula

incise trapezius parallel to spine of scapula

Question 8

DANGERS!!

Answer 8

Axillary nerve - 5-7cm from tip of acromion