CPT® Code 23920

Disarticulation of the shoulder, as described by CPT® Code 23920, refers to the surgical amputation of the arm at the shoulder joint. This procedure is infrequently performed and is typically reserved for patients with severe conditions such as extensive malignant tumors or significant traumatic injuries that necessitate the removal of the arm. The procedure involves a meticulous surgical approach, beginning with a subclavicular incision along the lateral third of the clavicle. This incision allows the surgeon to access the underlying structures, including the pectoralis major muscle, which is carefully dissected to create a pathway between the pectoralis minor and subclavian muscles. The subclavian vein and artery are then exposed, ligated, and divided to ensure proper blood flow management during the procedure. The surgical steps continue with the creation of skin incisions that facilitate the detachment of various muscles from the humerus, including the deltoid, supraspinatus, and infraspinatus. The procedure also involves severing the long head of the biceps, long head of the triceps, and teres minor muscles, along with the pectoralis major. The neurovascular bundle is exposed, and critical nerves, such as the axillary nerve, are identified and transected to complete the disarticulation. After all necessary soft tissues and the shoulder capsule are divided, the arm is removed, and the remaining musculature is closed. The deltoid muscle is sutured over the underlying structures, and drains may be placed as needed to manage postoperative fluid accumulation. This comprehensive approach ensures that the procedure is performed with precision, addressing the complex anatomy of the shoulder region while preparing the patient for recovery.