A wide and versatile combined surgical approach to the shoulder

Several surgical approaches to the shoulder have been described, each one allows somewhat limited exposure of either aspect of the shoulder joint. Dealing with complex conditions and injuries may necessitate wide exposures of both anterior and posterior aspects of the shoulder. The most commonly used approach for such complex conditions today is wide anterior Deltopectoral approach. Nevertheless, one may have to severe the Deltoid muscle by perfonning to extensive detachment in order to expose the posterior aspect as well. This may lead to Marked deterioration of its function, with prolonged and difficult post operative rehabilitation. We describe a simple combined new approach to the shoulder which allows easy access to anterior, lateral and posterior regions of the shoulder joint. The combined approach consists of anterior Deltopectoral approach, in conjunction with subcutaneously performed Deltoid split approach. This approach utilizes single skin incision, while, avoiding detachment of muscles with no risk of Damage to the Deltoid Muscle or the Axillary nerve. During the operation it is possible to shiR fi'om one approach to the other as needed, or to work conjointly from both approaches under the muscular bridge, without disturbing its insertions or nerve supply. This approach proved itself useful in the operative treatment of older patients suffering recurrent shoulder dislocations combined with rotator cuff tears, and for open reduction and internal fixation of conuninuted fractures of the humeral head. The post operative rehabilitation and mobilization of the joint can be carried out early and without any limitations as well. We believe this surgical technique provides another useful tool in the arsenal of the shoulder surgeon.
(J Shoulder Elbow Surg I999;8:658-9.)