The trapezius-splitting approach: modifications for treating disorders and traumas occurring in the lateral...

Disorders or traumas requiring surgery other than suprascapular entrapment neuropathy that occur in the lateral supraspinatus fossa are decidedly uncommon. Because a wider operative field is necessary for treating these disorders, we have applied a trapezius-splitting approach with some modifications.

The procedure comprises a saber cut incision along with trapezius-splitting of 5 cm to 6 cm proximally from the position coinciding with the posterior margin of the acromioclavicular joint. At the lateral aspect of this division, a Gelpi retractor is set on the clavicle and the scapular spine to widen the narrow interspace between them. The underlying adipose tissue and supraspinatus muscle are forced aside en bloc posteriorly. Four patients were surgically treated using this approach and were postoperatively followed up for 22.2 months ± 7.8 months.

A sufficient operative field for the major maneuver was secured in all four patients. None developed postoperative paralysis or atrophy of the trapezius, supraspinatus, or infraspinatus muscles. The three patients treated for nonunion or delayed union of coracoid fracture exhibited successful union, and the patient treated for osteochondroma of the clavicle had no recurrence.

The main advantages of this procedure are minimal trauma to the musculature, a clearly visible field of the most lateral fossa, and the ability to approach the anterior or posterior shoulder region through the extended skin incision and deltoid-splitting approach if required. Results indicate that the procedure would be advantageous in the surgical treatment of disorders and traumas occurring in the lateral supraspinatus fossa.