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:
    1. Proximal humerus fracture-dislocations.
    2. Glenoid fractures/osteotomy.
    3. Removal loose bodies from the shoulder joint.
    4. Irrigation and debridement of septic joint.
    5. Scapular neck fractures.
    6. Biopsy and excision of tumors.
    7. 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:
    1. Prone position is the most common used.
    2. Lateral position.
    3. Beach-chair position.

  • Landmarks:
    1. Acromion.
    2. 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.

  • The structures at risk during  the posterior approach to the shoulder (Judet approach) include:

    1. Suprascapular nerve:
      • It passes around the base of the scapular spine (do not retract infraspinatus too vigorously).
    2. 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.

  • Surgical Exposures in Orthopaedics book - 4th Edition
  • Campbel's Operative Orthopaedics book 12th
Posterior Approach to the shoulder Posterior Approach to the shoulder Posterior Approach to the shoulder Posterior Approach to the shoulder Posterior Approach to the shoulder Posterior Approach to the shoulder Posterior Approach to the shoulder Posterior Approach to the shoulder Posterior Approach to the shoulder
Images Source:
  • Surgical Exposures in Orthopaedics 4th Edition Book.
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