Deltopectoral Approach to the Shoulder - ShoulderDoc.co.uk
Deltopectoral Approach to the Shoulder - ShoulderDoc.co.uk
Deltopectoral Approach to the Shoulder - ShoulderDoc.co.uk
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<strong>Del<strong>to</strong>pec<strong>to</strong>ral</strong> <strong>Approach</strong><br />
<strong>to</strong> <strong>the</strong> <strong>Shoulder</strong><br />
Lennard Funk<br />
Manchester<br />
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong>
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong><br />
Utility <strong>Approach</strong>
Suitable for:<br />
1. Arthroplasty<br />
2. Anterior Stabilisation procedures<br />
3. Proximal Humeral Fractures<br />
4. Glenoid Fractures<br />
5. Combined procedures<br />
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong>
Not Suitable for:<br />
1. Rota<strong>to</strong>r Cuff Surgery<br />
2. Posterior Stabilisations<br />
3. AC Joint<br />
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong>
Advantages<br />
• Potential for extension<br />
• Exposure<br />
• Little bleeding (betw. Muscle planes)<br />
• Internervous plane<br />
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong>
Disadvantages<br />
• Difficulty exposing glenoid<br />
• Access <strong>to</strong> greater tuberosity & Cuff<br />
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong>
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong><br />
Preparation
Instruments<br />
• Retrac<strong>to</strong>rs<br />
– Norfolk-Norwich<br />
– Richards<br />
– Gelpi<br />
– Kolbel<br />
• Humeral Head Retrac<strong>to</strong>rs<br />
– F<strong>uk</strong>uda<br />
– Skid<br />
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong>
Position<br />
Head & Neck Secured<br />
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong><br />
Knees bent<br />
30 degrees Scapula Wedge<br />
Arm free
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong>
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong><br />
Incision
Cephalic vein<br />
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong><br />
Radkowski et al. An Ana<strong>to</strong>mic Study of <strong>the</strong> Cephalic Vein in <strong>the</strong><br />
<strong>Del<strong>to</strong>pec<strong>to</strong>ral</strong> <strong>Shoulder</strong> <strong>Approach</strong>. CORR. 442:139-142, January 2006.
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong><br />
Cora<strong>co</strong>id is <strong>the</strong> ‘lighthouse’ <strong>to</strong> <strong>the</strong> shoulder
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong>
Subdel<strong>to</strong>id & Subpec<strong>to</strong>ral Spaces<br />
thora<strong>co</strong>acromial<br />
artery<br />
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong>
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong><br />
Clavipec<strong>to</strong>ral Fascia
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong><br />
Axillary & Musculocutaneous Nerves
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong><br />
Musculocutaneous Nerve
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong><br />
Anterior Circumflex
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong><br />
Subscapularis
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong><br />
Anterior Capsule
Extensions<br />
• Inferior:<br />
– pec major release<br />
– Medial del<strong>to</strong>id from clavicle superiorly<br />
• Superior:<br />
– Detach Del<strong>to</strong>id from acromion<br />
– Clavicle osteo<strong>to</strong>my<br />
• Medial<br />
– Conjoined tendon release<br />
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong>
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong><br />
Pec major & Conjoined Tendon Releases
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong><br />
Clavicle Osteo<strong>to</strong>my
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong><br />
Clavicular Osteo<strong>to</strong>my
Combined <strong>Approach</strong><br />
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong><br />
Levy et al. JSES 1999
THANK YOU<br />
Images <strong>co</strong>urtesy of:<br />
– Operative <strong>Shoulder</strong> Surgery – Copeland<br />
– Primal Pictures<br />
– Lars Neumann, Nottingham<br />
Presentation published in <strong>the</strong> Education Section at<br />
www.shoulderdoc.<strong>co</strong>.<strong>uk</strong><br />
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong>
<strong>Shoulder</strong>doc.<strong>co</strong>.<strong>uk</strong>
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