There are three ways that surgeons gain access to the shoulder through the subscapularis: (1) tenotomy, (2) lesser tuberosity osteotomy and (3) incision at the tendon insertion. We've touched on this a bit in a previous post. After over three decades of performing shoulder joint replacements we have found #3 to be the most useful and generally applicable.
The recent article referenced above compares in an in vitro model the stability of methods #1 and #2, noting that the lesser tuberosity osteotomy has enjoyed a recent increase in popularity. Their results show that tenotomy (#1) had less displacement on cyclical testing than osteotomy (#2). Of course cyclical loading is what happens as the shoulder is rehabilitated after an arthroplasty. How these laboratory results relate to the clinical experience is not known, but this is surely not evidence in favor of the osteotomy method.
This not withstanding, we continue to use the incision at the tendon insertion because it enables us to manage the wide variety of pathologies we encounter in shoulder reconstruction.
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Use the "Search the Blog" box to the right to find other topics of interest to you.
You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.
