A posterosuperior approach to the shoulder

An approach for a better surgical exposure of the posterior part the glenoid and the rotator cuff is presented as an alternative for the long deltopectoral incision that might be considered in specially selected cases. In shoulder arthroplasty, it can be used for bone grafting to reorient the glenoid, revision of a glenoid component, or repair of a large rotator cuff tear. This posterosuperior approach consists of an osteotomy of the lateral rim and posterior corner of the acromion, with reflection of part of the medial and posterior insertion of the deltoid muscle. A special plate is used for stable fixation of the osteotomy. The method has been used since 1994 for shoulder prosthesis insertion in 79 patients. In 72 patients with a total shoulder or hemiarthroplasty, the cuff was attenuated or ruptured in 24 and could be repaired in 22. Twenty-two patients underwent a bony procedure to reorient the glenoid surface. The average correction of the superior tilt was 7°. The external rotators are released from the bone and reattached, which might result in weakening of external rotation. This possible complication could not be confirmed at follow-up. The osteotomy healed in all but 1 patient. The fixation material had to be removed in 13.