Kantonsspital St.Gallen
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[Posterior approach to the shoulder]

Sandro F Fucentese & Dominik Abt

abstract

OBJECTIVE
Safe approach to the posterior shoulder and scapula.

INDICATIONS
Posterior shoulder stabilization. Posterior bony reconstruction of the glenoid. Corrective osteotomies of the glenoid. Treatment of scapular neck fractures. Treatment of posterior glenoid rim fractures. Treatment of fractures of the acromion. Arthrodesis of the shoulder. Biopsy. Tumor resection. Relative: shoulder joint replacement with simultaneous posterior glenoid reconstruction. Relative: treatment of posterior dislocated proximal humerus fractures.

CONTRAINDICATIONS
General contraindications.

SURGICAL TECHNIQUE
Landmarks: scapular spine and acromion. Incision depending on goal of surgery: from horizontal to oblique or vertical: - horizontal incision along the scapular spine to the posterior corner of acromion, - oblique incision along the lateral border of scapula. Authors' preference: angle bisector between scapular spine and lateral border of scapula. Detachment of the deltoid with a bony chip from scapular spine beginning laterally (subacromial space). Under the deltoid the infraspinatus is exposed. Approach to glenoid: the internervous plane is between the infraspinatus (suprascapular nerve) and teres minor (axillary nerve). Approach to scapular neck (attention: identify axillary nerve!): more dangerous internervous plane between teres minor (axillary nerve) and teres major (subscapular nerve). If needed, detachment of infraspinatus from tendinous insertion for better visualization of posterior capsule and glenoid.

POSTOPERATIVE MANAGEMENT
According to the operated pathology.

RESULTS
Results are according to the operated pathology. As an example, results from the authors' clinic are presented. Between 1982 to 1995, 24 patients (26 shoulders) with posterior instability underwent open posteroinferior capsular shift. Mean follow-up was 7.6 years. The average relative Constant-Murley Score amounted to 91%. Subjective result was good to excellent for 24 and fair for two shoulders. Recurrence occurred in 23% (all cases with surgery before index procedure or new trauma). No approach-related complications (weakness or insufficiency) were noted.
   
citation Fucentese S F, Abt D. [Posterior approach to the shoulder]. Oper Orthop Traumatol 2010; 22:188-95.
   
type journal paper/review (Translation2::getLang(): unknown language "". Use Translation2::setLang() to set a default language.)
date of publishing 5-2010
journal title Oper Orthop Traumatol (22/2)
ISSN electronic 1439-0981
pages 188-95
PubMed 20711829
DOI 10.1007/s00064-010-8064-3