The anteromedial approach for shoulder arthroplasty: The importance of the anterior deltoid

Protection of the anterior aspect of the deltoid muscle is critical to the success of shoulder arthroplasty. Between 1975 and 1980, 75 patients with 81 shoulder arthroplasties had exposure via the anteromedial approach with careful anterior deltoid detachment through fascial tissues, systematic repair, and standardized rehabilitation with early passive range of motion. As with other reports on arthroplasty, pain was significantly reduced and motion was improved. No anterior deltoid detachments occurred; deltoid strength was preserved. Greater postoperative deltoid strength was statistically associated with lesser postoperative pain, greater postoperative active elevation, improved limb function, and an enhanced overall result rating. To understand the contemporary indications for this approach better, those undergoing shoulder arthroplasty between 1990 and 1994 were assessed. The anteromedial approach was used in 14 of these 236 shoulders (5.9%). This approach is currently reserved for patients with frail anterior deltoids that will not tolerate retraction, with severely osteopenic humeral shafts that will not tolerate torsion, with extreme scarring and an inflexible deltoid muscle, with severe bony deformity, or with posterosuperior rotator cuff tearing requiring repair. The importance of the anterior deltoid in shoulder arthroplasty cannot be denied. Use of the extended deltopectoral approach with preservation of the deltoid origin insertion is a very positive step forward. In uncommon instances where added exposure is needed, the anteromedial approach with careful attention to incision and repair of the deltoid with appropriate postoperative rehabilitation can accomplish the goal of maintaining anterior deltoid function and enhancing the success of shoulder arthroplasty.