A posterior shoulder surgical approach combines the subperiosteal detachment of the deltoid from the scapular spine, described by McWhorter, with a lateral extension to include the lateral deltoid splitting of Codman. The glenohumeral joint is superiorly approached between the supraspinatus and infraspinatus tendons, or inferiorly between the infraspinatus and teres minor tendons. This approach was used in 42 shoulders with rotator cuff tears or posterior instability without complications of infection, failure of deltoid healing, or compromise of suprascapular or axillary nerves. This combined surgical approach provides excellent exposure of the superior and posterior shoulder, which is difficult to obtain by anterior or superior approaches. This approach may be used for repair of rotator cuff tears, posterior instability, and displaced posterior glenoid fractures.