Outcomes of scapulothoracic fusion in facioscapulohumeral muscular dystrophy: A systematic review

Abstract

Background Facioscapulohumeral muscular dystrophy (FSHD) is a rare condition associated with selective weakness of the muscles of the upper arm, face, and shoulder girdle, negatively affecting daily activities. Scapulothoracic arthrodesis may restore shoulder function and improve quality of life. The purpose of this review is to evaluate the outcomes and complications of scapulothoracic arthrodesis in FSHD patients. Methods Medline, Pubmed, and Embase were systematically searched. Studies were included if they described scapulothoracic arthrodesis in FSHD with follow-up, and outcomes were adequately reported. Thirteen eligible articles reported the outcomes of 199 arthrodesis in 130 patients. Results The mean gain of shoulder forward elevation and abduction were 45° (p < 0.05) and 40° (p < 0.05), respectively. There was an overall cosmetic satisfaction and improved performance of daily activities. There is limited and heterogeneous data on changes in pulmonary function, but such changes are clinically insignificant. The rate of complications was 41% of which 10% were serious, requiring an intervention or re-admission. The most common complications were hardware failure (8%), non-union (6%), and pneumothorax (5%). Discussion Scapulothoracic arthrodesis improved cosmesis, performance of daily activities and shoulder motion with no clinically significant loss of pulmonary function. The complication rate is high, and some are potentially serious.

Scapulothoracic tenodesis using hamstring tendon graft for treatment of problematic scapula winging: A new surgical technique

“…3,8,11 The union rate is seen to be higher with use of bone graft compared to without but iliac crest graft, which is often preferred, has a well-documented donor-site morbidity. 9,10,14 Scapulothoracic arthrodesis is known to have an overall pulmonary complication rate quoted at 46%, including iatrogenic lung injury from metalwork insertion, heamothoraces, pnuemothoraces, atelectasis and chest infections. 3 It is well-documented that occurrence of intercostal fusion (i.e.…”

“…3 A recent systematic review of the literature reported that scapulothoracic fusion was associated with a decrease in pulmonary function, with reports of overall reduction in post-operative mean lung vital capacity, FVC and forced expiratory volume. [14][15][16][17][18] The technique of ST described in this report does not rely on metalwork used in the traditional plate-and-screw-fixation method necessary for arthrodesis. Hence, patients avoid issues of implant failure or hardware-related fractures, as well as associated complications and re-operation.…”

“…3,8,11 The union rate is seen to be higher with use of bone graft compared to without but iliac crest graft, which is often preferred, has a well-documented donor-site morbidity. 9,10,14…”

“…3 A recent systematic review of the literature reported that scapulothoracic fusion was associated with a decrease in pulmonary function, with reports of overall reduction in post-operative mean lung vital capacity, FVC and forced expiratory volume. 14–18…”

Which Components of the Simple Shoulder Test Show Improvement After Scapulothoracic Fusion for Recalcitrant Scapular Winging? Clinical Results at a Minimum of 5 Years of Follow-up

“…In a study using EMG sensors fixed to the humerus and scapula, Harryman et al [12] demonstrated a high degree of functional motion in patients undergoing STF. This procedure was first described and is most commonly performed for scapulothoracic dysfunction in patients with muscular dystrophies such as facioscapulohumeral muscular dystrophy [5,7,8,14,15,18]. The procedure has been associated with improved cosmesis and overall function in patients with this rare condition.…”