AANA Lab Course 906- Técnicas Avanzadas de Cirugía de Hombro-Como acceder a la glenoides-Joaquin Sánchez-Sotelo, MD, PhD

Como acceder a la glenoides-Joaquin Sánchez-Sotelo, MD, PhD

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The 2019 AANA/ASES Advanced Shoulder Surgery Course presentation by Dr. Joaquin Sanchez-Sotelo from Mayo Clinic focuses on the glenoid approach in shoulder arthroplasty. Proper exposure of the glenoid is often regarded as the most challenging aspect of shoulder replacement surgery. While easier in cases of cuff arthropathy and fractures, factors making the approach more difficult include large muscular males, obese patients, shoulders with preoperative stiffness or prior surgery, and glenoid bone defects or excessive retroversion.<br /><br />Key technical considerations include using adequately sized lateral skin incisions and developing the deltopectoral interval from the clavicle to the proximal humerus. The cephalic vein is mobilized medially, and the deltoid is freed from subacromial adhesions, typically using a deltoid retractor. Adhesions between the conjoint tendon and subscapularis are released, followed by subscapularis tenotomy or lesser tuberosity osteotomy if necessary. Complete capsular release of the proximal humerus is performed, with a sufficiently low humeral osteotomy and removal of medial humeral osteophytes.<br /><br />The upper extremity is placed on a Mayo table or equivalent device to hold the arm in abduction, facilitating anterior capsular release. Retractors are placed posteriorly, anteriorly, and superiorly, allowing for full labrum resection and inferior capsular release.<br /><br />If exposure remains inadequate, surgeons should mentally re-assess prior steps for potential improvements, consider changing the posterior glenoid retractor, or apply muscle paralysis to optimize access. These strategies aim to ensure comprehensive glenoid visualization, essential for successful prosthetic shoulder surgery.

Keywords

glenoid approach

shoulder arthroplasty

shoulder replacement surgery

deltopectoral interval

subscapularis tenotomy

lesser tuberosity osteotomy

capsular release

humeral osteotomy

labrum resection

prosthetic shoulder surgery