An extensile exposure for subacromial derangements.

To allow adequate access to the subacromial region of the shoulder the authors designed a multipurpose approach. The exposure consists of an anterior and a posterior part. In the anterior part, the deltoid fibres are separated between the anterior and middle thirds form the acromioclavicular joint for 5 cm distally; this provides the required access for the management of impingement syndrome, calcific tendinitis, bicipital tendon lesions and most tears of the rotator cuff. By extending the anterior part of the incision posteriorly over the supraspinatus muscle, this muscle may be advanced laterally for closure of a large tear. With this approach, osteotomy of the acromion or detachment of the deltoid muscle is avoided so that the integrity of the deltoid mechanism is maintained.