Deltopectoral Approach

Examiner:

Can you describe the deltopectoral approach to the glenohumeral joint?

Candidate:
Certainly. The deltopectoral approach to the glenohumeral joint is commonly utilized for accessing the anterior aspect of the shoulder.
The procedure is typically performed under general anesthesia, sometimes supplemented with an interscalene block, with the patient positioned in the beach chair position.
The incision is made from 1–2 cm inferior to the tip of the coracoid process, extending towards the anterior axillary fold.
During dissection, the deltopectoral groove is identified by a distinct ‘yellow stripe’ of fat, which helps locate the cephalic vein lying within the groove.
The cephalic vein is usually reflected laterally to gain access to the interval between the deltoid and the pectoralis major muscles.
Once the interval is developed, the conjoined tendon arising from the coracoid process is identified and dissected free from the underlying subscapularis muscle.
This tendon is then retracted medially, with the option of partial division approximately 1 cm distal to the coracoid process. Subsequently, the subscapularis muscle and its tendon are identified by externally rotating the arm.
Stay sutures are used to control the medial musculotendinous tissues of the subscapularis, allowing for safe division of the tendon about 1–2 cm from its insertion.
Depending on the indication, the subscapularis muscle is either stripped off the anterior capsule or the capsule is divided with the tendon to gain access to the glenohumeral joint.
During this approach, it’s crucial to be mindful of the nerves at risk. The axillary nerve, lying just inferior to the shoulder joint capsule, is protected by using a blunt ring-handled retractor to retract inferior structures away from the capsule.
Additionally, the musculocutaneous nerve should be safeguarded throughout the procedure.