Plasty lengthening of the subscapularis and outcomes with reverse shoulder arthroplasty

Abstract

Introduction Repair of the subscapularis attachment with reverse total shoulder replacement is important for internal rotation, in particular. Objective Evaluate subscapularis plasty techniques to improve shoulder internal rotation with reverse total shoulder arthroplasty. Material and methods Long-term results of shoulder arthroplasty using reverse systems were reviewed in 50 patients at 6 months to 6 years following the procedure. The patients reported problems with shoulder internal rotation and daily living chores having hand behind back with shoulder internal rotation restored to 68º and subscapularis muscles strength improved to 70 %. Technique of plasty lengthening of the subscapularis was offered to improve shoulder internal rotation with reverse total shoulder replacement. The method was used for 6 patients including 3 males and 3 females. Results Intraoperative measurements showed at least 90º of the passive shoulder internal rotation and 30º of external rotation. The practice allowed for subscapularis lengthening of 2 to 2.5 cm of intraoperative measurements. Clinical examination at 7 months to 1 year showed grade III mobilisation with the shoulder internal rotation in four patients following reverse shoulder arthroplasty and subscapularis plasty, and grade IV mobilisation in two patients. Constant Shoulder Score showed improvement of the shoulder by 67 % and measured 86 points with the Shoulder Rating Questionnaire. Shoulder internal rotation measured 3.4 ± 1.4 N/m that indicated to 83% improvement in subscapularis strength. Conclusion The technique offered showed functional improvements in shoulder internal rotation, anterior shoulder stabilization and the possibility with early rehabilitation.