Subscapularis function after total shoulder arthroplasty: electromyography, ultrasound, and clinical correlation

Armstrong, April; Southam, Jodi D.; Horne, Andrea H.; Hollenbeak, Christopher S.; Flemming, Donald J.; Kothari, Milind J.

doi:10.1016/j.jse.2016.02.018

Cited by 30 publications

(22 citation statements)

References 17 publications

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“…7,10 Failure rates of SSC repairs following shoulder arthroplasty procedures have been observed as high as 6.7% to 47.2%. [10][11][12][13][14][15] Proposed risk factors for postoperative SSC rupture include multiple surgeries with poor-quality tissue, insufficient repair techniques, compromise of the tendon repair resulting from various SSC lengthening techniques, overstuffing of the joint due to oversized prosthetic components, and trauma or inadequate physical therapy during the early postoperative period. [8][9][10]16,17 In response to these results, different modifications of SSC detachment and repair techniques have been developed, aiming to reduce iatrogenic damage and improve postoperative strength and durability of the SSC tendon.…”

Section: Introductionmentioning

confidence: 99%

Subscapularis Insufficiency: What’s All the Fuss About?

Böhm

Scheibel

Lädermann

2018

Journal of Shoulder and Elbow Arthroplasty

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There has been increase attention to the surgical treatment of the subscapularis (SSC) tendon with risk of postoperative dysfunction and early failures following shoulder arthroplasty. Studies investigating the clinical results after shoulder arthroplasty indicate that SSC tendon detachment or incision techniques and rehabilitation concepts may impair SSC recovery and consequently the postoperative function. In response to these results, technical modifications have been proposed and evaluated anatomically, biomechanically, and clinically. The aim of this article is to give an overview of current SSC takedown approaches, subsequent repair techniques, and postoperative rehabilitation protocols as well as to present the diagnostic algorithm and clinical impacts of the increasingly acknowledged condition of SSC insufficiency following shoulder arthroplasty procedures.

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Section: Introductionmentioning

confidence: 99%

Subscapularis Insufficiency: What’s All the Fuss About?

Böhm

Scheibel

Lädermann

2018

Journal of Shoulder and Elbow Arthroplasty

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“…A recent study by Armstrong et al 3 reported on the results of EMG evaluation of the subscapularis in postoperative anatomic TSA patients. They included 30 patients who underwent anatomic TSA with subscapularis tenotomy, at least 1 year from surgery.…”

Section: Discussionmentioning

confidence: 99%

Subscapularis integrity, function and EMG/nerve conduction study findings following reverse total shoulder arthroplasty

Khazzam¹,

Reyes²,

Phelan³

et al. 2020

JSES International

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Background During reverse total shoulder arthroplasty, the functionality of the subscapularis remains unknown. The purpose of this study was to determine the integrity and function of the repaired subscapularis after reverse total shoulder arthroplasty using ultrasound, electromyography (EMG), and nerve conduction studies (NCS) to assess postoperative tendon healing, muscle, and nerve function. Materials and methods Patients who underwent reverse total shoulder arthroplasty and repair with minimum 6-month follow-up were included in the study. Patient-reported outcome, physical examination, ultrasound examination of the subscapularis tendon, subscapularis EMG, and lower subscapular NCS were performed. In addition, contralateral subscapularis ultrasound, EMG, and lower subscapular nerve nerve NCS were performed to establish normative values (abnormal defined at >20% increased latency or >50% decreased amplitude). Phi coefficients of association and point biserial coefficients were used to correlate the ultrasound examination, EMG, and NCS results with the functional outcomes. Results A total of 20 patients were included. Four patients had abnormal but intact subscapularis tendons on ultrasound. Nine patients had abnormal lower subscapular NCS compared with the contralateral shoulder. All patients had normal subscapularis EMGs. No significant correlation was found between the ultrasound and NCS results. No significant correlations were found between the ultrasound or the NCS results and any of the independent outcome variables. Conclusion This study demonstrates that the subscapularis remains neurologically functional after reverse total shoulder arthroplasty, based on EMG and NCS findings. Although side-to-side differences in lower subscapular NCS were identified in 45% of the postoperative shoulders, these abnormalities did not correlate with functional outcomes.

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“…Typically, anatomic TSR is performed through the deltopectoral interval (Mueller & Hoy, 2014;Wolff & Rosenzweig, 2017). Through this fascial split the surgeon gains access to the shoulder joint either via a subscapularis division (peel technique or mid-substance tenotomy) or a lesser tuberosity osteotomy (LTO) approach (Armstrong et al, 2016;Choate et al, 2018).…”

Section: Surgical Approachmentioning

confidence: 99%

“…Of importance, however, is subscapularis function following anatomic TSR. Subscapularis dysfunction is associated with an inferior clinical result, evidenced by pain, weakness or anterior instability (Armstrong et al, 2016;Choate et al, 2018). A recent meta-analysis of the biomechanical data reported the load-to-failure of the initial repair to be stronger for the LTO approach, while there was no statistically significant difference under cyclic load testing between the different SP and ST techniques (Schrock et al, 2016).…”

Section: Surgical Approachmentioning

confidence: 99%

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Rehabilitation following anatomic total shoulder replacement for osteoarthritis

Blacknall¹,

Bidwai²

2020

NZJP

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Advances in anatomic total shoulder replacement (TSR) have seen this become an established surgical intervention for patients suffering from glenohumeral osteoarthritis (OA). A growing evidence-base stresses good prosthesis survivorship, low complication rates, and reproducible improvements to patients' quality of life and function. Despite these advances, the rehabilitation of patients undergoing anatomic TSR has received relatively little attention. This clinical commentary discusses a specific clinical method taken to manage patients undergoing anatomic TSR for glenohumeral OA and an intact rotator cuff. It outlines the evaluation-based rehabilitation approach developed between surgeons and physiotherapists at the Sherwood Forest Hospitals NHS Foundation Trust in Nottinghamshire, United Kingdom. It is hoped this commentary will generate further interest in this area and help drive advances in the outcomes and rehabilitation of patients undergoing TSR.

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Subscapularis function after total shoulder arthroplasty: electromyography, ultrasound, and clinical correlation

Cited by 30 publications

References 17 publications

Subscapularis Insufficiency: What’s All the Fuss About?

Subscapularis Insufficiency: What’s All the Fuss About?

Subscapularis integrity, function and EMG/nerve conduction study findings following reverse total shoulder arthroplasty

Rehabilitation following anatomic total shoulder replacement for osteoarthritis

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