Preoperative Assessment

Before surgery, the surgeon must determine the position in which the scapula will be fixed to the thoracic wall. This is done with the patient standing and the surgeon behind the patient.

A, The surgeon steadies the scapula with one hand by holding its superomedial border with the thumb and fingers. With the thumb of the opposite hand, the surgeon hooks the inferior angle of the scapula while the palm and fingers grasp the thoracic cage laterally. The patient’s arm hangs loosely at the side.

B, The inferior angle of the scapula is displaced laterally until the medial border of the scapula is parallel to the longitudinal axis of the spinous processes of the vertebrae. With the scapula fixed on the thoracic cage, the patient actively abducts the shoulder, and the degree of glenohumeral active abduction is measured. In this illustration, active shoulder abduction is 80 degrees.

C, The inferior angle of the scapula is displaced laterally, thus rotating the scapula laterally in the coronal (scapular) plane. In this illustration the medial border of the scapula is tilted laterally 40 degrees in relation to the vertebral spines. The patient is asked to actively abduct the shoulder, and the total range of thoracoglenohumeral abduction is measured and correlated with the scapuloaxial angle (the angle formed by the medial border of the scapula and a longitudinal line connecting the spinous processes of the vertebrae).