28
Shoulderdoc.co.uk Deltopectoral Approach to the Shoulder Lennard Funk Manchester

Deltopectoral Approach to the Shoulder

Embed Size (px)

Citation preview

Page 1: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Deltopectoral Approach to the Shoulder

Lennard Funk Manchester

Page 2: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Utility Approach

Page 3: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Suitable for:

1.  Arthroplasty 2.  Anterior Stabilisation procedures 3.  Proximal Humeral Fractures 4.  Glenoid Fractures 5.  Combined procedures

Page 4: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Not Suitable for:

1.  Rotator Cuff Surgery 2.  Posterior Stabilisations 3.  AC Joint

Page 5: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Advantages

•  Potential for extension •  Exposure •  Little bleeding (betw. Muscle planes) •  Internervous plane

Page 6: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Disadvantages

•  Difficulty exposing glenoid •  Access to greater tuberosity & Cuff

Page 7: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Preparation

Page 8: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Instruments

•  Retractors – Norfolk-Norwich – Richards – Gelpi – Kolbel

•  Humeral Head Retractors – Fukuda – Skid

Page 9: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Position Head & Neck Secured

Knees bent 30 degrees Scapula Wedge

Arm free

Page 10: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Page 11: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Incision

Page 12: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Cephalic vein

Radkowski et al. An Anatomic Study of the Cephalic Vein in the Deltopectoral Shoulder Approach. CORR. 442:139-142, January 2006.

Page 13: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Coracoid is the ‘lighthouse’ to the shoulder

Page 14: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Page 15: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Subdeltoid & Subpectoral Spaces

thoracoacromial artery

Page 16: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Clavipectoral Fascia

Page 17: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Axillary & Musculocutaneous Nerves

Page 18: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Musculocutaneous Nerve

Page 19: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Anterior Circumflex

Page 20: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Subscapularis

Page 21: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Anterior Capsule

Page 22: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Extensions

•  Inferior: – pec major release – Medial deltoid from clavicle superiorly

•  Superior: – Detach Deltoid from acromion – Clavicle osteotomy

•  Medial – Conjoined tendon release

Page 23: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Pec major & Conjoined Tendon Releases

Page 24: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Clavicle Osteotomy

Page 25: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Clavicular Osteotomy

Page 26: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

Combined Approach

Levy et al. JSES 1999

Page 27: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk

THANK YOU

Images courtesy of: –  Operative Shoulder Surgery – Copeland –  Primal Pictures –  Lars Neumann, Nottingham

Presentation published in the Education Section at www.shoulderdoc.co.uk

Page 28: Deltopectoral Approach to the Shoulder

Shoulderdoc.co.uk