How To Tell If You Are Lost

It is possible to be too far anterior or posterior with this approach, especially in overweight patients who do not have much muscle definition. It is difficult to tell whether you are lost anteriorly or posteriorly because both the biceps and the triceps fibers are running parallel to the humerus. The main thing to do is feel the humerus. The deltoid insertion is a good landmark more proximally. It is in the interval between the biceps and the triceps. Once you find that insertion, you will also find the interval between those muscles, which will guide you directly to the humerus.

Case 8 Lateral Approach to the Humerus • 27

FIGURE 8—3 The interval between the biceps and triceps developed so that there is ready access to the humeral shaft.

FIGURE 8-1 The skin incision.

FIGURE 8—3 The interval between the biceps and triceps developed so that there is ready access to the humeral shaft.

FIGURE 8—2 The subcutaneous tissue spread showing the underlying muscle. The posterior aspect of the biceps is visible.

FIGURE 8—4 The biceps anterior to the brachialis origin and the triceps posterior.

O Biceps E3! Triceps Q Humerus

D Radial Nerve Q Deltoid Insertion

FIGURE 8—5 The dissection proceeding proximally, showing the fibers of the deltoid coming in obliquely along with the white deltoid insertion.

D Biceps E Triceps Q Humerus

FIGURE 8—6 The incision extended distally, showing the radial nerve as it starts to wrap around the humerus coming from posterior to anterior at the junction of the middle and distal thirds.

□ Radial Nerve 0 Deltoid Insertion

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