4

TRANSACROMIAL APPROACH

USES

This approach is used for repair of massive rotator cuff tears that require more exposure than can be obtained with an acromioplasty.

ADVANTAGES

This approach gives an excellent view of the entire supraspinatus muscle and tendon, and of the rest of the rotator cuff as it inserts into the humeral head. It is possible to obtain this wide exposure without stripping the deltoid off of the acromion.

DISADVANTAGES

Because it splits the acromion in two, this approach requires an extra step in the surgery to internally fix the acromion. If the acromion goes on to nonunion, the patient will experience pain with the use of the shoulder.

STRUCTURES AT RISK

The deltoid is split with this approach and if it is split more than 4 cm distally, the axillary nerve is at risk.

If the bone split is too anterior, there is the risk of damage to the clavicle. If it is too posterior, there is the risk of splitting into the spine of the scapula.

TECHNIQUE

The technique is the same as that for the deltoid splitting approach (see Case 3). The incision, however, is carried more medially, usually to the medial aspect of the acromion. This V

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