Anterolateral Approach to the Shoulder

The anterolateral approach to the shoulder:

  • It offers excellent exposure to the acromioclavicular joint and the coracoacromial ligament and supraspinatus tendon, and it’s used for:
    1. Rotator cuff repair.
    2. Repair of the long head of the biceps.
    3. Acromioclavicular joint decompression.
    4. Anterior shoulder decompression.

  • The patient is Placed in the supine position on the operating table in a beach chair position, with a sandbag under the spine and medial border of the scapula to push the affected side forward .

  • Landmarks:
    1. Coracoid Process
    2. Acromion.
  • Incision:
    • Make a transverse incision that begins at the anterolateral corner of the acromion and ends just lateral to the coracoid process.

  • There is no internervous plane for the anterolateral approach to the shoulder (deltoid split proximally to the axillary nerve).

  • The superficial fascia is encountered and incised.
  • Superficial vessels are numerous; attention must be paid to these to facilitate visualization.
  • The deltoid is then sharply released from the acromion or clavicle, depending on area of surgical need,
    • This should be limited, as deltoid repair is often difficult.
  • The acromial branch of the thoracoacromial artery must be ligated when encountered deep to the deltoid, near the acromioclavicular joint.

  • The coracoacromial ligament is then released from the acromion
    • The ligament can be excised by releasing it from the coracoid as well
  • The subacromial bursa is now seen and can be excised to reveal rotator cuff pathology

  • Structures at risk during anterolateral approach to the shoulder include:

    1. Axillary nerve
      • This nerve runs transversely across the surface of the deltoid muscle approximately 7 cm distal to the acromion
    2. Acromial branch of the thoracoacromial artery
      • Runs directly under the deltoid muscle

  • Surgical Exposures in Orthopaedics - 4th Edition
Anterolateral Approach to the shoulder Anterolateral Approach to the shoulder Anterolateral Approach to the shoulder Anterolateral Approach to the shoulder Anterolateral Approach to the shoulder
Images Source:
  • Surgical Exposures in Orthopaedics 4th Edition Book.

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