Accession Number : ADA614479


Title :   Quantification of the Exposure of the Glenohumeral Joint from the Minimally Invasive to More Invasive Subscapularis Approach to the Anterior Shoulder: a Cadaveric Study


Descriptive Note : Journal article


Corporate Author : SAN ANTONIO MILITARY MEDICAL CENTER FORT SAM HOUSTON TX


Personal Author(s) : Bellamy, Jaime L ; Johnson, Anthony E ; Beltran, Michael J ; Hsu, Joseph R


Full Text : https://apps.dtic.mil/dtic/tr/fulltext/u2/a614479.pdf


Report Date : 01 Jun 2014


Pagination or Media Count : 8


Abstract : Background: There are multiple techniques to approach the glenohumeral joint. Our purpose was to quantify the average area of the glenohumeral joint exposed with 3 subscapularis approaches and determine the least invasive approach for placement of shoulder resurfacing and total shoulder arthroplasty instruments. Methods: Ten forequarter cadaveric specimens were used. Subscapularis approaches were performed sequentially from split, partial tenotomy, and full tenotomy through the deltopectoral approach. Glenohumeral joint digital photographs were analyzed in Image J software (National Institutes of Health, Bethesda, MD, USA). Shoulder resurfacing and total shoulder arthroplasty instruments were placed on the humeral head, and anatomic landmarks were identified. Results: The average area of humeral head visible, from the least to the most invasive approach, was 3.2, 8.1, and 11.0 sq cm, respectively. The average area of humeral head visible differed significantly according to the approach. Humeral head area increased 157% when the subscapularis split approach was compared with the partial tenotomy approach and 35% when the partial approach was compared with the full tenotomy approach. The average area of glenoid exposed from least to most invasive approach was 2.0, 2.3, and 2.5 sq cm, respectively. No significant difference was found between the average area of the glenoid and the type of approach. Posterior structures were difficult to visualize for the subscapularis split approach. Partial tenotomy of the subscapularis allowed placement of resurfacing in 70% of the specimens and total arthroplasty instruments in 90%. Conclusions: The subscapularis splitting approach allows adequate exposure for glenoid based procedures, and the subscapularis approaches presented expose the glenohumeral joint in a step wise manner.


Descriptors :   *SHOULDERS(ANATOMY) , CADAVERS , HUMERUS , MUSCLES , SURGERY , TENDONS


Subject Categories : Medicine and Medical Research


Distribution Statement : APPROVED FOR PUBLIC RELEASE