Anterolateral approach to the Shoulder

Position

• supine
• Mayfield headrest
• Sandbag under spine & medial border of scapula
• Beachchair 45°
• Prep & drape limb free

Landmarks

• Clavicle
• Acromion
• Spine of scapular
• Coracoid process

Incision

• Transverse incision
• Start: anterolateral corner of acormion
• End: just lateral of coracoid process

Internervous Plane

• None
  • Deltoid muscle is detached proximal to nerve supply

Superficial Dissection

• Subcutaneous fat
• Ligate numerous vessels
• Deep fascia
• Palpate AC joint
• Detach fibres of deltoid from AC joint & continue laterally to expose 1cm of anterior aspect of acromion
• Ligate acromial branch of coracoacromial artery
• Split deltoid in line of its fibres starting at AC joint
  • Extend 5cm
  • Insert stay sutures at apex of split to avoid damage to axillary nerve

Deep Dissection

• Detach coracoacromial ligament from acromion
• You can now see supraspinatus & SA bursa
• Rotate humeral head to expose different parts of R/C & long head of biceps

Dangers

• Axillary nerve
  • Runs transversely deep to deltoid 7cm below tip of acromion
• Acromial branch of coracoacromial artery