Shoulder Surgical Approaches

Question 1

Uses for anterior (deltopectoral) approach?

Answer 1

1) Open rotator cuff (esp. subscapularis) or labral repairs
2) Arthroplasty (hemi vs. total)
3) Proximal humerus fxs

Question 2

Complications of anterior approach?

Answer 2

1) Subscap rupture

2) Neurapraxia (musculocutaneous or axillary n)

Question 3

Dangers of anterior approach?

Answer 3

1) Musculocutaneous n (w/ vigorous retraction)
2) Cephalic vein
3) Axillary vein

Question 4

What muscle must be opened and repaired in anterior approach?

Answer 4

Subscap

Question 5

Arthroscopy portals?

Answer 5

1) Posterior = primary viewing portal
2) Anterior superior = instruments
3) Anterior inferior = enters just above subscap tendon
4) Lateral = visualize RC and acromion
5) Wilmington = useful in repairs of RC and labrum
6) Neviaser (supraspinatus) = anterior glenoid view

Question 6

Posterior portal danger?

Answer 6

Posterior capsule/labrum

Question 7

Anterior superior portal danger?

Answer 7

Coracoacromial ligament and/or artery

Question 8

Anterior inferior portal danger?

Answer 8

Musculocutaneous n

Question 9

Lateral portal danger?

Answer 9

Axillary n (5cm distal)

Question 10

Wilmington portal danger?

Answer 10

Safe port

Question 11

Neviaser portal danger?

Answer 11

RC