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Posterior Approach to Shoulder

- See:
      - Anterior Approach Shoulder
      - Post Approach to Humerus

- Discussion:
     - indicated from frx of the scapula, esp when the pathology is posterior;

- Technique:
     - positon the patient in the prone or lateral position;
     - skin incision is made starting at the acromial angle and is directed medially and distally either along spine of scapula or alternatively make a verticle
            skin incision in the posterior axillary skin crease, extending from posterolateral corner of acromion to the the posterior axillary fold;
     - undermine skin flaps to expose the spine of scapula and acromion;
     - posterior portion and part of the lateral portion of the deltoid is detached from the spine and from lateral edge of the acromion;
     - approach involves splitting deltoid, at junction of its middle & posterior thirds;
            - this junction is marked by the posterior corner of the acromion;
            - this site overlies the joint and overlies axillary nerve which exits quadrangular space;
            - a stay suture should mark course of axillar nerve;
            - the deltoid can be split a distance of approximately 7 cm (below this lies the axillary nerve);
     - safe interval to the shoulder is thru the infraspinatus (suprascapular nerve) & teres minor (axillary nerve);
            - progressive internal rotation of the humerus will help protect the axillary nerve;
            - tendons of infraspinatus and teres minor are exposed w/ the infraspinatus retracted superiorly and the teres minor retracted inferiorly;
            - note excessive inferior retraction or inferior dissection may injure axillary nerve which enters the muscle from below;
            - the teres minor is incised vertically 2.5 cm from its insertion, allowing exposure of the shoulder joint capsule (be sure not to
                   injure the capsule during the dissection)

A posterior surgical approach to the proximal part of the humerus.

The posterior deltoid-splitting approach to the shoulder.