The return of subscapularis strength after shoulder arthroplasty

Lapner, Peter; Wood, Kristi S.; Zhang, Tinghua; Athwal, George S.

doi:10.1016/j.jse.2014.06.042

Cited by 30 publications

(23 citation statements)

References 29 publications

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“…In a prospective double-blind randomized-controlled trial comparing SST and LTO, no significant differences were observed at 2 years postoperatively between groups for functional outcome scores, healing rates, or subscapularis fatty degeneration. 17,32,33 In conclusion, all 3 approaches to subscapularis management appear to yield similar clinical results. Factors that should be taken into account in choosing an approach include surgeon skill, whether medialization of the tendon may be required, the degree of robustness of the subscapularis tendon, and the ability to follow the status of subscapularis healing postoperatively.…”

Section: Difficulty Of Assessmentmentioning

confidence: 77%

Surgical Approach and Dealing With the Subscapularis in Primary Shoulder Arthroplasty

Rollins¹,

Lapner²

2016

Techniques in Shoulder &Amp; Elbow Surgery

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The optimal management of the subscapularis tendon during total shoulder arthroplasty remains controversial. Subscapularis mobilization is required to gain access to the glenohumeral joint during the deltopectoral approach. Failure of the subscapularis to heal, or postoperative rupture, has been associated with poor clinical outcomes. Current evidence supporting subscapularis tenotomy, lesser tuberosity osteotomy, and subscapularis peel are summarized, as surgical techniques. Regardless of technique used, an anatomic and substantial repair with heavy nonabsorbable stitches and plate augmentation is necessary to withstand gentle postoperative rehabilitation. Lack of consensus may be due to difficulty of reliable clinical assessment of subscapularis function after shoulder arthroplasty and lack of agreement between clinical studies comparing techniques.

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Section: Difficulty Of Assessmentmentioning

confidence: 77%

Surgical Approach and Dealing With the Subscapularis in Primary Shoulder Arthroplasty

Rollins¹,

Lapner²

2016

Techniques in Shoulder &Amp; Elbow Surgery

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“…The incidence of total shoulder arthroplasty has been rising in the last decade 1 and there has been a trend towards smaller implants and more minimally invasive approaches 2 . As demonstrated by the joint registries 3 the most common approaches in current practice are the deltopectoral and antero-superior approaches, both of which violate the subscapularis tendon and can lead to long term dysfunction [4][5][6][7] . As a result, there has been a move towards rotator cuff sparing approaches.…”

Section: Introductionmentioning

confidence: 99%

Rotator cuff–sparing approaches for glenohumeral joint access: an anatomic feasibility study

Amirthanayagam

Amis

Reilly

et al. 2017

Journal of Shoulder and Elbow Surgery

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“…Many studies have demonstrated subscapularis dysfunction following a deltopectoral approach to the shoulder involving subscapularis takedown and repair. 2 , 5 , 15 , 16 , 19 , 20 , 21 , 27 , 28 , 29 , 30 Subscapularis dysfunction has been defined as decreased active internal rotation strength, positive subscapularis examination maneuvers (ie, lift-off, belly-press, and bear hug), and the inability to tuck in the shirt behind the back. This has been described in postoperative patients after anatomic TSA, 2 , 5 , 15 , 16 , 19 , 20 , 21 Latarjet procedures, open Bankart repair, 27 and open instability procedures.…”

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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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The return of subscapularis strength after shoulder arthroplasty

Cited by 30 publications

References 29 publications

Surgical Approach and Dealing With the Subscapularis in Primary Shoulder Arthroplasty

Surgical Approach and Dealing With the Subscapularis in Primary Shoulder Arthroplasty

Rotator cuff–sparing approaches for glenohumeral joint access: an anatomic feasibility study

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

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