AANA Middle East Arthroscopy Master Course (International)-Deep Dive _ Key Pearls Dissection Anatomy of the Shoulder

Deep Dive _ Key Pearls Dissection Anatomy of the Shoulder

Pdf Summary

This detailed presentation by Dr. Mark R. Hutchinson focuses on the surgical anatomy of the shoulder, emphasizing the importance of anatomy for both open and arthroscopic shoulder procedures. The discussion begins by comparing open and arthroscopic approaches, highlighting the commonly used deltopectoral (anterior) approach as the “workhorse” incision, along with posterior and lateral approaches.<br /><br />Key anatomical structures encountered during dissection are reviewed in depth. Muscles involved include the deltoid, pectoralis major and minor, coracobrachialis, biceps brachii (long and short heads), subscapularis, and latissimus dorsi. Ligaments such as the coracoacromial, coracoclavicular (trapezoid and conoid), and coracohumeral ligaments are described. Important vascular structures are the cephalic vein, axillary artery, anterior and posterior humeral circumflex arteries, and profunda brachii artery. Nerves at risk include the musculocutaneous, axillary, radial nerves, and the brachial plexus.<br /><br />The deltopectoral approach involves careful identification and mobilization of the cephalic vein, working between the deltoid and pectoralis major muscles, and understanding the internervous plane defined by their different nerve supplies. Deeper dissection involves detachment of the conjoined tendon from the coracoid and identification of the musculocutaneous nerve insertion. The axillary nerve and associated "three sisters" vessels run along the inferior border of the subscapularis. Techniques like the “tug test” help identify and protect these nerves intraoperatively.<br /><br />Posterior dissection focuses on the relationship of the deltoid and trapezius muscles to the rotator cuff and neurovascular structures, including the axillary nerve and posterior humeral circumflex artery within the quadrangular space, and the radial nerve in the triangular interval. The suprascapular nerve is tracked from the suprascapular notch to the spinoglenoid notch.<br /><br />Understanding these anatomical relationships and safe surgical corridors is crucial for procedures such as anterior instability repairs, shoulder arthroplasty, proximal humerus fracture fixation, subscapularis repair, and biceps tenodesis. Mastery of these details enhances the performance of both open and arthroscopic shoulder surgeries, ultimately improving surgical outcomes.

Keywords

shoulder surgical anatomy

deltopectoral approach

arthroscopic shoulder surgery

muscles of shoulder

shoulder ligaments

shoulder vascular structures

shoulder nerves

posterior shoulder dissection

shoulder surgical approaches

shoulder surgery complications