Introduction Overview this approach is infrequently used this approach offers access to the posterior and inferior aspects of the shoulder Indications proximal humerus fracture-dislocations glenoid fractures/osteotomy removal loose bodies irrigation and debridement of septic joint scapular neck fractures Internervous plane Internervous plane teres minor (axillary n.) infraspinatus (suprascapular n.) Preparation Anesthesia general anesthetic Table radiolucent flat-top table Patient Position prone is most common lateral beach-chair Approach Incision the patient is positioned in the lateral decubitus position with the ipsilateral arm draped free the incision is made along the scapular spine, extending to the lateral acromial border Superficial dissection attention must be paid to superficial skin vessels, as these can bleed significantly the origin of the deltoid is released from the scapular spine the plane between the deltoid and infraspinatus is encountered and bluntly developed this is typically easiest to find at the lateral aspect of the incision the deltoid is retracted distally/laterally Deep dissection the interval between the infraspinatus (suprascapular nerve) and teres minor (axillary nerve) is bluntly developed this is often difficult to find, but should be done carefully retract the infraspinatus superiorly and the teres minor inferiorly to expose the posterior glenoid and scapular neck Dangers Suprascapular nerve passes around the base of the scapular spine (do not retract infraspinatus too vigorously) Axillary nerve runs through the quadrangular space beneath the teres minor (stay superior to the teres minor) this is accompanied by the posterior circumflex humeral artery