Reverse shoulder arthroplasty with and without latissimus and teres major transfer for patients with combined loss of elevation and external rotation: a prospective, randomized investigation

Abstract

Background: Latissimus dorsi (LD) and teres major (TM) tendon transfers have been performed concurrently with reverse shoulder arthroplasty (RSA) to address combined loss of elevation and external rotation (CLEER) at the shoulder. The purpose of this prospective, randomized study was to compare RSA with and without LD-TM tendon transfer in patients with rotator cuff tear arthropathy and CLEER. Methods: Patients undergoing RSA for rotator cuff tear arthropathy who also had CLEER were randomized into the group undergoing RSA with tendon transfer or the group undergoing RSA without tendon transfer. The primary outcome measure was the Activities of Daily Living and External Rotation (ADLER) score 2 years after surgery. Secondary outcome measures included the Disabilities of the Arm, Shoulder and Hand (DASH) score, American Shoulder and Elbow Surgeons (ASES) score, and Simple Shoulder Test (SST) score. Results: Both the treatment and control groups showed significant improvements in the ability to perform activities of daily living requiring active external rotation measured by the ADLER score postoperatively. No significant difference in the ADLER, DASH, ASES, or SST score was found between the 2 groups at final follow-up. Resolution of the Hornblower sign occurred postoperatively in 58.3% of patients in the control group and 73.3% of those in the treatment group. Conclusion: No differences in the ADLER, DASH, ASES, and SST results were found between patients treated with RSA alone and those treated with RSA with LD-TM transfer for rotator cuff tear arthropathy and CLEER. Both groups showed significant improvements in all clinical outcome assessments including functional tasks that require active external rotation.

Can Lateralization of Reverse Shoulder Arthroplasty Improve Active External Rotation in Patients with Preoperative Fatty Infiltration of the Infraspinatus and Teres Minor?

“…Effectively, it has traditionally been implied for this condition that a latissimus dorsi transfer +/− teres major tendon transfer(s) be undertaken [31,32]. Our study demonstrated that an adequate prosthetic design could be sufficient to restore active external rotation, confirming other reports [33]. Consequently, due to the additional difficulty, increased operative time, associated loss of internal rotation [34], and increased neurological complication rate [35], primary transfers do no longer seem justified, as a simple change in prosthetic design could achieve similar results.…”

Mid-term outcomes after reverse total shoulder arthroplasty with latissimus dorsi transfer

“…In contrast, Young et al reported that there were no significant differences in ADLER, DASH, ASES, and SST scores for patients treated with RTSA alone or if the LDT was done concomitantly with RTSA. 15 This was done in a series of patients presenting with rotator cuff arthropathy and loss of range of motion. However, little data are available for patients presenting with other indications such as hemiarthroplasty revision or failed ORIF.…”

“…Most studies report follow-up of less than five years. [12][13][14][15] The purpose of this article is to report mid-term outcomes of RTSA with LDT. We hypothesized that positive outcomes will demonstrate an increase in range of motion and a reduced pain level that is sustained.…”

Understanding shoulder pseudoparalysis: Part I: Definition to diagnosis

“…This classification was developed after early observations of poorer outcomes of reverse shoulder arthroplasty (RSA) in combined pseudoparalytic syndromes especially with additional loss of ER ( 18 ). Treatment of CLEER is currently controversial, with some surgeons suggesting it should be treated with RSA combined with a simultaneous tendon transfer ( 17 , 19 , 20 ) and others suggesting that using a lateralized RSA prosthesis is adequate ( 21 , 22 ). It is the authors’ opinion and experience that there are patients who still suffer from loss of ER with a hornblower and dropping sign despite RSA lateralization ( Fig.…”