If weakness is an issue after shoulder arthroplasty, it may be due to (1) insufficient time and effort at rehabilitation (recognizing that shoulder joint replacement is performed on shoulders that have been 'out of action' for a long period of time with some disuse atrophy of the muscles), (2) technical problems with the arthroplaty, (3) nerve injuries, (4) rotator cuff defects, or (5) subscapularis tendon detachment.
In a technically well done joint replacement and in the absence of some intercurrent injury, persistence of the rehabilitation program will usually lead to progressively more strength and function. If this fails, the shoulder should be scrutinized for evidence of other causes of weakness as listed above.
Failure of the subscapularis reattachment may result from excessive early loading of the repair or from poor quality of the tendon.
This situation is suggested by weakness of internal rotation and be an increased range of external rotation.
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