Deltopectoral approach for shoulder arthroplasty: anatomic basis

Gadéa, François; Bouju, Yves; Berhouet, Julien; Bacle, Guillaume; Favard, Luc

doi:10.1007/s00264-014-2654-x

Cited by 24 publications

(23 citation statements)

References 44 publications

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“…Due to its relationship to the chest wall and breast, the PM can be considered as one of the key anatomical structures in plastic and reconstructive surgery [6–8]. The importance of PM in orthopedic surgery refers, among others, to the deltopectoral approach [9–12] or to the repair of PM injuries [6, 13–15]. At the same time, the PM belongs to muscles demonstrating high anatomical variability, which may affect performing imaging-based evaluation and understanding the injury findings [4, 16].…”

Section: Introductionmentioning

confidence: 99%

Anatomical Variations of the Pectoralis Major Muscle: Notes on Their Impact on Pectoral Nerve Innervation Patterns and Discussion on Their Clinical Relevance

Haładaj

Wysiadecki

Clarke

et al. 2019

BioMed Research International

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Background. The presented study attempts to classify individual anatomical variants of the pectoralis major muscle (PM), including rare and unusual findings. Rare cases of muscular anomalies involving the PM or its tendon have been presented. An attempt has also been made to determine whether anatomical variations of the PM may affect the innervation pattern of the lateral and medial pectoral nerves. Material and Methods. The research was carried out on 40 cadavers of both sexes (22 males, 18 females), owing to which 80 PM specimens were examined. Results. Typical PM structure was observed in 63.75% of specimens. The most frequently observed variation was a separate clavicular portion of the PM. In one female cadaver (2.5% of specimens) the hypotrophy of the clavicular portion of the PM was noticed. In two male cadavers (5% of specimens) the fusion between the clavicular portion of the PM and the deltoid muscle was observed. In one of those cadavers, small sub-branches of the lateral pectoral nerve bilaterally joined the clavicular portion of the deltoid muscle. The detailed intramuscular distribution of certain nerve sub-branches was visualized by Sihler’s stain. PM is mainly innervated by the lateral pectoral nerve. In all specimens stained by Sihler’s technique, the contribution of the intercostal nerves in PM innervation was confirmed. Conclusions. Surgeons should be aware of anatomic variations of the PM both in planning and in conducting surgeries of the pectoral region.

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Section: Introductionmentioning

confidence: 99%

Anatomical Variations of the Pectoralis Major Muscle: Notes on Their Impact on Pectoral Nerve Innervation Patterns and Discussion on Their Clinical Relevance

Haładaj

Wysiadecki

Clarke

et al. 2019

BioMed Research International

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“…In addition, it provides radiographic evidence of postoperative subscapularis disruption. This is at the expense of increased surgical difficulty, risk of intraoperative fracture or postoperative nonunion, 10 and risk of fatty degeneration of the subscapularis. 4,17…”

Section: Lto Techniquementioning

confidence: 98%

“…The subscapularis tendon is released starting superiorly at the rotator interval, working inferiorly while gradually externally rotating the arm until the inferior osteophyte is visible. 10 The anterior humeral circumflex artery is ligated as it crosses the inferior portion of the tendon. The subscapularis and anterior capsule are usually incised together, and to control the subscapularis for soft tissue releases, 2 or 3 traction sutures are then placed through the tendon.…”

Section: Subscapularis Tenotomy (Sst)mentioning

confidence: 99%

Surgical Approach and Dealing With the Subscapularis in Primary Shoulder Arthroplasty

Rollins¹,

Lapner²

2016

Techniques in Shoulder &Amp; Elbow Surgery

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The optimal management of the subscapularis tendon during total shoulder arthroplasty remains controversial. Subscapularis mobilization is required to gain access to the glenohumeral joint during the deltopectoral approach. Failure of the subscapularis to heal, or postoperative rupture, has been associated with poor clinical outcomes. Current evidence supporting subscapularis tenotomy, lesser tuberosity osteotomy, and subscapularis peel are summarized, as surgical techniques. Regardless of technique used, an anatomic and substantial repair with heavy nonabsorbable stitches and plate augmentation is necessary to withstand gentle postoperative rehabilitation. Lack of consensus may be due to difficulty of reliable clinical assessment of subscapularis function after shoulder arthroplasty and lack of agreement between clinical studies comparing techniques.

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“…The surgical technique for RTSA can be accomplished via two approaches: deltopectorally or superolaterally [3,9]. The deltopectoral approach is the most common and requires an experienced surgeon [10].…”

Section: Surgical Approachmentioning

confidence: 99%

Current Outcomes Following Reverse Total Shoulder Arthroplasty: A Composite

Cryder¹,

Perry²,

Beverly³

2018

Advances in Shoulder Surgery

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Reverse Total Shoulder Arthroplasty (RTSA) is a popular treatment for patients with rotator cuff damage, glenohumeral arthritis, complex fractures, and previously failed total shoulder arthroplasty given its ability to alleviate pain and increase range of motion and function. Although RTSA significantly improves functionality, pain, and satisfaction, patients need to be given realistic expectations for when to expect improvements, peak performance, and plateaus as well as potential risks for negative outcomes. As with any surgical procedure, patients are at risk for intraoperative, perioperative, short-term, and long-term complications. Thus, the purpose of this review is to discuss the short-term and long-term complications, metrics, and length of follow-up for patients who have undergone RTSA. In addition, we provide recommendations for a cutoff point between short-term and long-term outcomes for RTSA.

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Deltopectoral approach for shoulder arthroplasty: anatomic basis

Abstract: - The safe plane for going around the humeral head and positioning retractors is the plane of the subacromial deltoid bursa. - Always stay close to the bone during capsule release, whether on the humeral or glenoid side. - Never go medially to the conjoint tendon or its deep face.

Cited by 24 publications

References 44 publications

Anatomical Variations of the Pectoralis Major Muscle: Notes on Their Impact on Pectoral Nerve Innervation Patterns and Discussion on Their Clinical Relevance

Anatomical Variations of the Pectoralis Major Muscle: Notes on Their Impact on Pectoral Nerve Innervation Patterns and Discussion on Their Clinical Relevance

Surgical Approach and Dealing With the Subscapularis in Primary Shoulder Arthroplasty

Current Outcomes Following Reverse Total Shoulder Arthroplasty: A Composite

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