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  • Deltopectoral Approach To The Shoulder: Lennard Funk

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    Chrysi Tsiouri
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    This document describes the deltopectoral approach to the shoulder, which provides exposure for procedures like arthroplasty, fracture repairs, and anterior stabilizations. It has advantages of good exposure between muscle planes with little bleeding, but disadvantages of difficulty visualizing the glenoid and accessing the greater tuberosity. The approach involves making an incision over the deltopectoral groove, separating muscle planes, protecting surrounding nerves, and using retractors as needed for extensions.

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    This document describes the deltopectoral approach to the shoulder, which provides exposure for procedures like arthroplasty, fracture repairs, and anterior stabilizations. It has advantages of good exposure between muscle planes with little bleeding, but disadvantages of difficulty visualizing the glenoid and accessing the greater tuberosity. The approach involves making an incision over the deltopectoral groove, separating muscle planes, protecting surrounding nerves, and using retractors as needed for extensions.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    16 views28 pages

    Deltopectoral Approach To The Shoulder: Lennard Funk

    Uploaded by

    Chrysi Tsiouri
    This document describes the deltopectoral approach to the shoulder, which provides exposure for procedures like arthroplasty, fracture repairs, and anterior stabilizations. It has advantages of good exposure between muscle planes with little bleeding, but disadvantages of difficulty visualizing the glenoid and accessing the greater tuberosity. The approach involves making an incision over the deltopectoral groove, separating muscle planes, protecting surrounding nerves, and using retractors as needed for extensions.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 28

    Deltopectoral Approach

    to the Shoulder

    Lennard Funk
    Manchester

    Shoulderdoc.co.uk
    Utility Approach

    Shoulderdoc.co.uk
    Suitable for:

    1.  Arthroplasty
    2.  Anterior Stabilisation procedures
    3.  Proximal Humeral Fractures
    4.  Glenoid Fractures
    5.  Combined procedures

    Shoulderdoc.co.uk
    Not Suitable for:

    1.  Rotator Cuff Surgery


    2.  Posterior Stabilisations
    3.  AC Joint

    Shoulderdoc.co.uk
    Advantages

    •  Potential for extension


    •  Exposure
    •  Little bleeding (betw. Muscle planes)
    •  Internervous plane

    Shoulderdoc.co.uk
    Disadvantages

    •  Difficulty exposing glenoid


    •  Access to greater tuberosity & Cuff

    Shoulderdoc.co.uk
    Preparation

    Shoulderdoc.co.uk
    Instruments
    •  Retractors
    –  Norfolk-Norwich
    –  Richards
    –  Gelpi
    –  Kolbel
    •  Humeral Head Retractors
    –  Fukuda
    –  Skid

    Shoulderdoc.co.uk
    Position
    Head & Neck Secured

    Knees bent
    30 degrees Scapula Wedge
    Arm free
    Shoulderdoc.co.uk
    Shoulderdoc.co.uk
    Incision

    Shoulderdoc.co.uk
    Cephalic vein

    Radkowski et al. An Anatomic Study of the Cephalic Vein in the


    Deltopectoral Shoulder Approach. CORR. 442:139-142, January 2006.
    Shoulderdoc.co.uk
    Coracoid is the ‘lighthouse’ to the shoulder

    Shoulderdoc.co.uk
    Shoulderdoc.co.uk
    Subdeltoid & Subpectoral Spaces

    thoracoacromial
    artery

    Shoulderdoc.co.uk
    Clavipectoral Fascia

    Shoulderdoc.co.uk
    Axillary & Musculocutaneous Nerves

    Shoulderdoc.co.uk
    Musculocutaneous Nerve

    Shoulderdoc.co.uk
    Anterior Circumflex

    Shoulderdoc.co.uk
    Subscapularis

    Shoulderdoc.co.uk
    Anterior Capsule

    Shoulderdoc.co.uk
    Extensions
    •  Inferior:
    –  pec major release
    –  Medial deltoid from clavicle superiorly
    •  Superior:
    –  Detach Deltoid from acromion
    –  Clavicle osteotomy
    •  Medial
    –  Conjoined tendon release

    Shoulderdoc.co.uk
    Pec major & Conjoined Tendon Releases

    Shoulderdoc.co.uk
    Clavicle Osteotomy

    Shoulderdoc.co.uk
    Clavicular Osteotomy

    Shoulderdoc.co.uk
    Combined Approach

    Levy et al. JSES 1999


    Shoulderdoc.co.uk
    THANK YOU

    Images courtesy of:


    –  Operative Shoulder Surgery – Copeland
    –  Primal Pictures
    –  Lars Neumann, Nottingham

    Presentation published in the Education Section at


    www.shoulderdoc.co.uk

    Shoulderdoc.co.uk
    Shoulderdoc.co.uk

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