Open surgical approaches to the shoulder

Wiethoelter MJ; Schoenborn A; Katthagen JC

Abstract

The choice of surgical approach to the shoulder joint depends on the indication, the surgeon's experience, and patient-specific factors. The deltopectoral approach is the standard for many procedures, such as stabilization, fracture treatment, or arthroplasty procedures, and allows safe exposure of ventral structures. Protecting the cephalic vein, the anterior circumflex humeral artery, the musculocutaneous nerve, and the axillary nerve is crucial. The lateral deltoid-splitting approach is especially suitable for greater tuberosity fractures or mini-open rotator cuff reconstructions. In this approach, safeguarding the axillary nerve and the fibers of the deltoid muscle is essential. The modified posterolateral approach, according to Brodsky, enables muscle-sparing treatment of glenoid and scapular fractures on the posterior side. The interval between the infraspinatus and teres minor muscles should be identified, and the axillary and suprascapular nerves protected. Acromioclavicular (AC) joint injuries and clavicle fractures can be treated openly using the longitudinal-cranial approach. With this method, sparing the supraclavicular nerve branches is advisable when possible. Restoring the deltotrapezoid fascia is vital to prevent complications. Other approaches, such as the Judet approach or transacromial procedures, are rarely used today due to high complication rates. Preoperative marking of bony landmarks, a soft tissue-sparing technique, and knowledge of anatomical danger zones are essential to avoid iatrogenic injuries.