title: [Posterior approach to the shoulder].
abstract: OBJECTIVE
  Safe approach to the posterior shoulder and scapula.
  
  
  METHODS
  Posterior shoulder stabilization. Posterior bony reconstruction of the glenoid. Corrective osteotomies of the glenoid. Treatment of scapular neck fractures. Treatment of posterior glenoid rim fractures. Treatment of fractures of the acromion. Arthrodesis of the shoulder. Biopsy. Tumor resection. Relative: shoulder joint replacement with simultaneous posterior glenoid reconstruction. Relative: treatment of posterior dislocated proximal humerus fractures.
  
  
  METHODS
  General contraindications.
  
  
  METHODS
  Landmarks: scapular spine and acromion. Incision depending on goal of surgery: from horizontal to oblique or vertical: - horizontal incision along the scapular spine to the posterior corner of acromion, - oblique incision along the lateral border of scapula. Authors' preference: angle bisector between scapular spine and lateral border of scapula. Detachment of the deltoid with a bony chip from scapular spine beginning laterally (subacromial space). Under the deltoid the infraspinatus is exposed. Approach to glenoid: the internervous plane is between the infraspinatus (suprascapular nerve) and teres minor (axillary nerve). Approach to scapular neck (attention: identify axillary nerve!): more dangerous internervous plane between teres minor (axillary nerve) and teres major (subscapular nerve). If needed, detachment of infraspinatus from tendinous insertion for better visualization of posterior capsule and glenoid.
  
  
  METHODS
  According to the operated pathology.
  
  
  RESULTS
  Results are according to the operated pathology. As an example, results from the authors' clinic are presented. Between 1982 to 1995, 24 patients (26 shoulders) with posterior instability underwent open posteroinferior capsular shift. Mean follow-up was 7.6 years. The average relative Constant-Murley Score amounted to 91%. Subjective result was good to excellent for 24 and fair for two shoulders. Recurrence occurred in 23% (all cases with surgery before index procedure or new trauma). No approach-related complications (weakness or insufficiency) were noted.
authors: Departement für Orthopädische Chirurgie, Uniklinik Balgrist, Universität Zürich, Schweiz.
authors: Sandro F
authors: SF
authors: Fucentese
authors: Bernhard
authors: B
authors: Jost
mesh_terms: D000173:Acromioclavicular Joint / Q000293:injuries* / Q000601:surgery*; D001174:Arthrodesis / Q000379:methods; D001706:Biopsy; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012540:Scapula / Q000293:injuries*; D012782:Shoulder / Q000601:surgery*; D012783:Shoulder Dislocation / Q000601:surgery*; D012784:Shoulder Fractures / Q000601:surgery*; D000070599:Shoulder Injuries; D012983:Soft Tissue Neoplasms / Q000473:pathology / Q000601:surgery*