After the anesthetic has been administered and the shoulder has been prepared, a cosmetic incision is made in a natural skin crease at the front of the shoulder as shown in the figure above. This incision allows access to the seam between the deltoid and the pectoralis major muscles. Splitting this seam allows access to the shoulder without detaching or damaging the important deltoid muscle, which is responsible for a significant portion of the shoulder's power.
All scar tissue is removed from the space beneath the deltoid.
The tendon of the subscapularis muscle is incised, providing excellent access to the interior of the shoulder joint and a view of the detachment of the labrum and ligaments from the glenoid socket, as shown in the figure above. The goal of the repair is to reattach securely the labrum and ligaments to the area from which they were torn. This is accomplished by roughening the edge of the glenoid socket and drilling small holes through its lip in the area of the tear. At the conclusion of the repair the subscapularis tendon is repaired anatomically, as shown in the figure below. A cosmetic closure of the skin incision is carried out, dressings are applied, and the arm is placed in a sling.