The axillary nerve crosses the inferolateral border of the subscapularis 3 to 5 mm medially of its musculotendinous junction and has an intimate anatomic relation with the inferior capsule of the shoulder joint. The anterior humeral circumflex artery and veins are visualized, ligated and divided. The subscapularis tendon is released, divided 1 cm medially to its attachment or released with a bone chip of the lesser tuberosity. Separation of the subscapularis from the capsule and incision of the capsule is performed to the inferior border of the glenoid rim, protecting the axillary nerve with a blunt retractor. Release the subscapularis and perform a 360° capsular release. Antero-lateral (deltoid splitting) approach Begin the incision at the anterolateral tip of the acromion and carry it distally over the deltoid muscle about 5 cm. Define the tendinous interval on 4 to 5 cm long between the anterior and middle thirds of the deltoid; splitting the muscle here provides an avascular approach to underlying structures. Incise the thin wall of the subdeltoid bursa and explore the rotator cuff as desired by rotating and abducting the arm to bring different parts of it into view in the floor of the wound.
Closure After the definitive prosthesis has been implanted, repair of the subscapularis is recommended for reverse shoulder arthroplasty and required for anatomic shoulder arthroplasty. In case of anatomic reconstruction evaluate after reattachment of the subscapularis if closure of the rotator interval is needed for further stability or not. Closure of the deltopectoral fascia, subcutaneous adaptation and skin closure is then performed.
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