Proximal Humerus

Question 1

What is the plane for a deltopectoral approach to the shoulder?

Answer 1

Deltoid (axillary n.) and pectoralis major (medial and lateral pectoral n.)

Question 2

What is encountered during the superficial dissection of the deltopectoral approach?

Answer 2

1) Deltopectoral fascia
2) cephalic vein (in fat stripe); can take medially (cauterize deltoid perforators) or laterally (higher likelihood of injury)

Question 3

Where does the musculocutanoues nerve enter the biceps tendon?

Answer 3

5-8cm distal to coracoid process; it enters the coracobrachialis 2.5cm from coracoid process

Question 4

What landmarks can help find the anterior circumflex humeral a.?

Answer 4

It lies cephalad to the pectoralis major tendon

Question 5

What are the landmarks for the deltopectoral approach?

Answer 5

Coracoid process, proximal humeral shaft, deltopectoral interval (skinnier or muscular people)

Question 6

How much of the deltoid insertion can be released to increase exposure?

Answer 6

No more than 1/5 of the footprint

Question 7

What interval does the lateral approach to the proximal use?

Answer 7

Deltoid splitting; useful for IM nailing and tuberosity fractures