- Transdeltoid lateral approach
Usage: Exposure of greater tuberosity
The transdeltoid lateral (or deltoid-splitting) approach is appropriate for limited operations that need only to expose the greater tuberosity and the most proximal part of the humeral head.
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Incision
Begin the incision at the anterolateral tip of the acromion and carry it distally over the deltoid muscle for about 5 cm.
Define the tendinous interval for 4 to 5 cm between the anterior and middle thirds of the deltoid; splitting the muscle here provides a fairly avascular approach to underlying structures.
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Split deltoid
For maximum exposure, split the deltoid up to the margin of the acromion, but do not split it distally more than 4-5 cm from its origin to avoid damaging the axillary nerve and paralyzing the anterior part of the deltoid.
The axillary nerve runs transversely just proximal to the midpoint between the lateral margin of the acromion and the insertion of the deltoid.
The greater tuberosity fragment can be mobilized and reduced with the shoulder abducted and rotated in different directions.