Anterolateral Approach to the Shoulder indications:

Anterolateral Approach to the Shoulder offers excellent exposure to the acromioclavicular joint and the coracoacromial ligament and supraspinatus tendon, and it’s used for:

  1. Rotator cuff repair.
  2. Repair of the long head of the biceps.
  3. Acromioclavicular joint decompression.
  4. Anterior shoulder decompression.

The use of arthroscopic subacromial decompression has reduced the use of this approach in the treatment of impingement syndrome and for some cases of rotator cuff repair.

Anterolateral Approach to the Shoulder, however, remains clinically relevant in large numbers of cases involving extensive degenerative disease of the rotator cuff.

Position of the Patient

  • The patient is Placed in the supine position on the operating table in a beach chair position, with a sandbag under the spine and medial border of the scapula to push the affected side forward .

Landmarks and Incision

  • Landmarks:
    1. Coracoid Process
    2. Acromion.
  • Incision:
    • Make a transverse incision that begins at the anterolateral corner of the acromion and ends just lateral to the coracoid process.
Anterolateral Approach to the shoulder

Internervous plane

  • There is no internervous plane for the anterolateral approach to the shoulder (deltoid split proximally to the axillary nerve).

Superficial dissection

  • The superficial fascia is encountered and incised.
  • Superficial vessels are numerous; attention must be paid to these to facilitate visualization.
  • The deltoid is then sharply released from the acromion or clavicle, depending on area of surgical need,
    • This should be limited, as deltoid repair is often difficult.
  • The acromial branch of the thoracoacromial artery must be ligated when encountered deep to the deltoid, near the acromioclavicular joint.
Anterolateral Approach to the shoulder

Deep dissection

  • The coracoacromial ligament is then released from the acromion
    • The ligament can be excised by releasing it from the coracoid as well
  • The subacromial bursa is now seen and can be excised to reveal rotator cuff pathology

Approach Extension

The Anterolateral Approach to the Shoulder can’t be extended proximally or distally.

Dangers

Structures at risk during anterolateral approach to the shoulder include:

  1. Axillary nerve
    • This nerve runs transversely across the surface of the deltoid muscle approximately 7 cm distal to the acromion
  2. Acromial branch of the thoracoacromial artery
    • Runs directly under the deltoid muscle

References

  • Surgical Exposures in Orthopaedics – 4th Edition