Shoulder/Arm Approaches Flashcards
position for anterior approach to the clavicle
supine
elevate head
sandbag between scapula and spine
incision for anterior approach to the clavicle
start medial after palpating subcutaneous border of clavicle
internervous plane for anterior approach to the clavicle
none
superficial dissection for anterior approach to the clavicle
through platysma
diathermy vessels
deep dissection for anterior approach to the clavicle
strip soft tissue off clavicle in epiperiosteal plane
danger for anterior approach to the clavicle
1) brachial plexus
2) subacromial artery and vein immediately inferior to clavicle - avoid inferior dissection
position for anterior approach to shoulder joint
supine
sandbag between scapula and spine
elevate table 30°
incision for anterior approach to shoulder joint
10-15 cm along deltopectoral groove starting at corocoid
alternatively, you can use the axillary incision, which is vertical in the axilla starting at the anterior crease
internervous plane for anterior approach to shoulder joint
between deltoid and pecs
superficial dissection for anterior approach to shoulder joint
retract pec medial and delt lateral
take the cephalic vein in the convenient direction
deep dissection for anterior approach to shoulder joint
displace the short head of biceps and coracobrachialis medially
osteotomize the corocoid if necessary with the arm adducted (takes brachial plexus and artery away from field)
retract corocoid medially
externally rotate to ID subscap
divide subscap 1 cm from insertion and use stay sutures to anchor it (or take some bone with it)
incise joint capsule where appropriate
danger for anterior approach to shoulder joint
1) MSK nerve as it enters the coracobrachialis 5-8 cm distal to corocoid
2) cephalic vein
position for anterolateral approach to the AC joint and subacromial space
supine
sandbag between scapula and spine
elevate head 45°
incision for anterolateral approach to the AC joint and subacromial space
transvers incision beginning at the anterolateral corner of the acromion ending just lateral ato the coracoid
internervous plane for anterolateral approach to the AC joint and subacromial space
none - delt is detached
superficial dissection for anterolateral approach to the AC joint and subacromial space
fascia
palpate AC joint
ligate the coracoacromial artery
spare as much deltoid as possible
split delt 5 cm down if approaching for rotator cuff repair
deep dissection for anterolateral approach to the AC joint and subacromial space
detach coracoacromial ligament from acromion and coracoid - remove for decompression of teh subacromial space
danger for anterolateral approach to the AC joint and subacromial space
1) axillary nerve runs deep to delt 7 cm below the acromion
2) acromial branch of the coracoacromial artery must be ligated just under the delt as you approach
position for lateral approach to proximal humerus
supine with arm at edge of table
elevate head of table
sandbag for shoulder
incision for lateral approach to proximal humerus
5 cm longitudinal from tip of acromion down lateral arm
internervous plane for lateral approach to proximal humerus
none - split delt
superficial dissection for lateral approach to proximal humerus
split delt in line with fibres from acromion down
insert stay suture at inferior margin
deep dissection for lateral approach to proximal humerus
incise subacromial bursa
expose humerus and rotator cuff
danger for lateral approach to proximal humerus
1) axillary nerve 7 cm below acromion travelling transversely under delt
*note that the minimally invasive lateral approach is also available with 2 incisions, but the key is ID the axillary nerve and go deep to it*
position for posterior approach to the shoulder joint
lateral
stand behind
incision for posterior approach to the shoulder joint
linear along scapular spine extending to posterior corner of acromion