[The Kessel-Gschwend approach to the shoulder joint]

The solution of pathological conditions in the subacromial space is essentially not only a diagnostic problem but also a problem of the surgical approach. Exposure of the necessary space is practically always associated with slackening of the muscles; usually the deltoid muscle is affected which leads to hypotrophy, frequently to muscular atrophy with an adverse impact on the function of the shoulder joint. Gschwend's modification of Kessel's approach reduces muscular hypotrophy and the risk of damage to a minimum and permits to treat the described affections of the shoulder joint, with rapid restoration of normal function of the joint. The approach was used for the surgical treatment of injuries of the rotator cuff, impingement syndrome and other diseases with favourable results.