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Exposure of the Glenohumeral Joint for Total Shoulder Arthroplasty

March 15, 2015

Contributors: Christen R. Mellano, MD; Nikhil N Verma, MD; Brian J Cole, MD, MBA, FAAOS; CAPT (Ret) Matthew T. Provencher, MD MC USNR; Anthony A Romeo, MD, FAAOS; Rachel M Frank, MD; Rachel M Frank, MD

Adequate exposure of the glenohumeral joint can be extremely difficult even in seemingly routine total shoulder arthroplasty (TSA) cases. The steps necessary to achieve adequate exposure start well before the incision is made, beginning with appropriate patient positioning and draping strategies. The development of appropriate intervals and myofascial planes is critical in ensuring sufficient visualization of the glenohumeral joint, without injuring the surrounding neurovascular structures. Shoulders with advanced osteoarthritis can be especially problematic, as severe posterior glenoid wear patterns can lead to an excessively retroverted glenoid, making exposure of the entire glenoid surface challenging. Meticulus retractor placement during exposure of the glenohumeral joint is of utmost importance, so as to avoid injury to nearby neurovascular structures, including the musculocutaneous and axillary nerves. Careful tissue handling, including that of the subscapularis, is also paramount to ensuring sufficient exposure of the joint, and can be accomplished either via lesser tuberosity osteotomy or via subscapularis tenotomy. Further exposure of the glenohumeral joint is accomplished via capsular release. In this video we describe a safe, reproducible, and reliable surgical technique for the exposure of the glenohumeral joint for performing open procedures such as total shoulder arthroplasty. The background, basic science, typical patient presentation, imaging findings, techniques, rehabilitation protocol, and clinical outcomes are reviewed in detail.

Results for "Surgical Exposure"