Glenoid Exposure During Shoulder Replacement

Glenoid exposure for total shoulder replacement can be challenging and represents the most difficult part of the procedure. Exposure requires both humeral and glenoid-based releases. We prefer a lesser tuberosity osteotomy instead of a subscapularis takedown. The osteotomy offers significant advantages for glenoid visualization by decreasing the encroachment of anterior humeral bone. Specific glenoid-based releases are then performed in this sequential fashion: 1) the rotator interval including the coracohumeral and superior glenohumeral ligament is released, 2) the middle glenohumeral ligament is divided in an inferior direction, 3) the inferior glenohumeral ligament is then divided as the inferior extension of the above dissection, and 4) posterior glenoid retractors are placed and the axillary nerve is directly visualized. An inferior capsular release then is performed dependent on the necessity of further exposure.