Subscapular and Pectoralis Major Sparing Deltopectoral Approach for Reverse Total Shoulder Arthroplasty

Abstract

In reverse ball shoulder replacement, surgery is usually performed using a deltopectoral approach or an anterosuperior transdeltoid approach. The deltopectoral approach is to incise the pectoralis major to upper 1/3 to 1/2, and subscapularis tendon should be removed at the lesser tuberosity of the humerus. This approach has the problem of breaking the shoulder deltoid instead of incising the rotator cuff. Therefore, we report a detailed procedure of reverse ball shoulder replacement using approach without incision of the pectoralis major muscle and subscapularis muscle.

Keywords: Anterosuperior transdeltoid approach; Deltopectoral approach; Reverse ball shoulder replacement.

Fig. 1.

Representative perioperative images of the deltopectoral approach to reverse total shoulder arthroplasty. (A) After confirmation of the rotator interval and resection of the upper arm, during which the biceps tendon long head remains intact, the remaining synovium and joints of the humeral head are removed, and the humeral head is exposed upward. (B, C) When the arm is extended, the humerus head is exposed at the rotator interval, and, if space is sufficient, the elbow is pushed upward and the humerus head is pushed up through the space within the rotator interval. (D, E) When and appropriate level of osteotomy has been performed, the tip of a Hohmann retractor is placed on the inferior pole of the joint and the osteotomized humerus is pushed downward along the humerus shaft, while the Hohmann retractor is moved forward and backward to expose the glenoid fossa. (F) Postoperative X-ray of completed shoulder arthroplasty.