Surgical Exposures of the Shoulder

Chalmers, Peter N.; Thiel, Geoff S. Van; Trenhaile, Scott W.

doi:10.5435/jaaos-d-14-00342

Cited by 18 publications

(8 citation statements)

References 36 publications

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“…A recent JAAOS review has covered the deltopectoral approach in detail. 23 The approach begins with assessment of the position of previous incisions. Although the deltopectoral interval is infrequently palpable in revision cases, the coracoid and deltoid tuberosity are identifiable in most individuals and can provide guidelines for proper location of the incision.…”

Section: Approachmentioning

confidence: 99%

Revision Reverse Shoulder Arthroplasty

Chalmers

Boileau

Romeo

et al. 2019

J Am Acad Orthop Surg

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As shoulder arthroplasty becomes increasingly common, the burden of revision shoulder arthroplasty is also increasing. Revision reverse shoulder arthroplasty requires an understanding of the causes of failure and the evaluation of these causes and their sequelae, including infection, instability, component loosening, humeral bone loss, and glenoid bone loss. Revision reverse shoulder arthroplasty is technically complex. On the humeral side, corticotomy may be required for component removal, and bone grafting may be necessary to achieve rotational stability and to restore humeral length and avoid undertensioning and instability. On the glenoid side, bone loss is common, structural bone grafting is not infrequently required, and proper component positioning is required to avoid impingement and component loosening. Although the outcomes are generally inferior to primary reverse total shoulder arthroplasty and complications and revision surgeries are common, revision procedures still lead to notable improvements in pain, motion, and function. InfectionInfection remains a difficult-to-treat complication after shoulder arthroplasty. Over half of all postoperative

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Section: Approachmentioning

confidence: 99%

Revision Reverse Shoulder Arthroplasty

Chalmers

Boileau

Romeo

et al. 2019

J Am Acad Orthop Surg

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“…When approaching the shoulder joint anteriorly, the subscapularis muscle may have to be tenotomized, removed from the lesser tubercle or split in line with the muscle fibers [ 20 , 21 ]. This needs to be done among other procedures for shoulder arthroplasty and exposure of the glenoid during a Latarjet procedure.…”

Section: Discussionmentioning

confidence: 99%

Variations in Subscapularis Muscle Innervation—A Report on Case Series

et al. 2020

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Background and objectives: The subscapularis muscle is typically innervated by two distinct nerve branches, namely the upper and lower subscapular nerve. These usually originate from the posterior cord of the brachial plexus. A large number of variations have been described in previous literature. Materials and Methods: Dissection was carried out in 31 cadaveric specimens. The frequency of accessory subscapular nerves was assessed and the distance from the insertion points of these nerves to the myotendinous junction was measured. Results: Accessory subscapular nerves were found in three cases (9.7%). According to their origin from the posterior cord of the brachial plexus proximal to the thoracodorsal nerve all three nerves were identified as accessory upper subscapular nerves. No accessory lower subscapular nerves were found. Conclusion: Accessory nerves occur rather commonly and need to be considered during surgery, nerve blocks, and imaging procedures.

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“…The deltopectoral approach provides an internervous and intermuscular plane through which a variety of shoulder procedures can be performed. 1 It also allows for distal extension to improve visualization, and access to distal aspects of the humeral shaft, which becomes of particular utility when exposure of the proximal humerus is not sufficient.…”

Section: Introductionmentioning

confidence: 99%

Surgically relevant anatomy of the axillary and radial nerves in relation to the latissimus dorsi tendon in variable shoulder positions: A cadaveric study

et al. 2019

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Background The purpose of this study was to define the relationship of the axillary and radial nerves, particularly how these are affected with changing arm position. Methods Twenty cadaveric shoulders were dissected, identifying the axillary and radial nerves. Distances between the latissimus dorsi tendon and these nerves were recorded in different shoulder positions. Positions included adduction/neutral rotation, abduction/neutral rotation for the axillary nerve, adduction/internal rotation, adduction/neutral rotation, adduction/external rotation, and abduction/external rotation for the radial nerve. Results Width of the latissimus tendon at its humeral insertion was 29.3 ± 5.7 mm. Mean distance from the latissimus insertion to the axillary nerve in adduction/neutral rotation was 24.2 ± 7.1 mm, the distance increased to 41.1 ± 9.8 mm in abduction/neutral rotation. Mean distance from the latissimus insertion to the radial nerve was 15.3 ± 5.5 mm with adduction/internal rotation, 25.8 ± 6.9 mm in adduction/neutral rotation, and 39.5 ± 6.8 mm in adduction/external rotation. Mean distance increased with abduction/external rotated 51.1 ± 7.4 mm. Conclusions Knowing the axillary and radial nerve locations relative to the latissimus dorsi tendon decreases the risk of iatrogenic nerve injury. Understanding the dynamic nature of these nerves related to different shoulder positions is critical to avoid complications.

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Surgical Exposures of the Shoulder

Cited by 18 publications

References 36 publications

Revision Reverse Shoulder Arthroplasty

Revision Reverse Shoulder Arthroplasty

Variations in Subscapularis Muscle Innervation—A Report on Case Series

Surgically relevant anatomy of the axillary and radial nerves in relation to the latissimus dorsi tendon in variable shoulder positions: A cadaveric study

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