Posterior Approach to the shoulder (Judet Approach)
- The posterior approach to the shoulder (Judet Approach) offers access to the posterior and inferior aspects of the shoulder joint. It can be used for:
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- Proximal humerus fracture-dislocations.
- Glenoid fractures/osteotomy.
- Removal loose bodies from the shoulder joint.
- Irrigation and debridement of septic joint.
- Scapular neck fractures.
- Biopsy and excision of tumors.
- Repairs in cases of recurrent posterior dislocation or subluxation of the shoulder.
- The best positions in the posterior approach to the shoulder (Judet Approach) are:
- Prone position is the most common used.
- Lateral position.
- Beach-chair position.
- Landmarks:
- Acromion.
- The spine of the scapula.
- Incision:
- The incision is made along the scapular spine, extending to the lateral acromial border.
- Internervous plane lies between:
- Teres minor muscle (axillary nerve).
- Infraspinatus muscle (suprascapular nerve).
- Attention must be paid to superficial skin vessels, as these can bleed significantly,
- The origin of the deltoid is released from the scapular spine,
- The plane between the deltoid and infraspinatus is encountered and bluntly developed,
- This is typically easiest to find at the lateral aspect of the incision,
- The deltoid is retracted distally/laterally.
- The interval between the infraspinatus (suprascapular nerve) and teres minor (axillary nerve) is bluntly developed,
- This is often difficult to find, but should be done carefully.
- Retract the infraspinatus superiorly and the teres minor inferiorly to expose the posterior glenoid and scapular neck.
- The incision cannot be extended usefully.
- Its main goal is to provide access to the posterior aspect of the shoulder joint.
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The structures at risk during the posterior approach to the shoulder (Judet approach) include:
- Suprascapular nerve:
- It passes around the base of the scapular spine (do not retract infraspinatus too vigorously).
- Axillary nerve:
- It runs through the quadrangular space beneath the teres minor (stay superior to the teres minor).
- This is accompanied by the posterior circumflex humeral artery.
- Suprascapular nerve:
- Surgical Exposures in Orthopaedics book - 4th Edition
- Campbel's Operative Orthopaedics book 12th