Since 1980, the authors have used a posterior approach to the glenohum
eral joint in which the posterior deltoid is split caudally in line wi
th its fibers from the posterior acromion to the upper border of the t
eres minor. The extent of this deltoid splitting approach exceeds that
of a similar anterior approach because of the distal emergence of the
axillary nerve from the quadrilateral space. This technique gives com
plete access to the infraspinatus and teres minor muscles and tendons,
posterior capsule, and posterior glenoid. Unlike traditional posterio
r approaches to the shoulder joint that detach a portion or all of the
origin of the deltoid, this technique preserves the deltoid origin fr
om the scapular spine and posterior acromion. Over the past 11 years,
this posterior approach has been performed in 35 patients (42 shoulder
s): 31 for posterior instability, one for posterior glenohumeral fract
ure-dislocation, eight for infection, and two for removal of foreign b
odies. The median age of the patients was 33.8 years (range, 13-65 yea
rs). The mean duration of follow-up contact was 20 months (range, one
month to 11.4 years). Two patients died of unrelated causes and three
were lost to follow-up examination. The posterior deltoid-splitting ap
proach is advocated for any procedure requiring posterior access to th
e glenohumeral joint because it provides excellent exposure, has been
associated with no complications, and preserves the strength and funct
ion of the posterior deltoid.