Monday, December 31, 2012

Reverse total shoulder - scapular motion

How does scapula motion change after reverse total shoulder arthroplasty? - a preliminary report

This report examines changes in scapular position after reverse total shoulder arthroplasty in seven patients having reverse total shoulder arthroplasty for cuff tear arthropathy from July 2007 to October 2008. The distance between the long axis of the thoracic spine and the inferior pole of the scapula (lateralization of the scapula) was measured on shoulder A-P radiographs at 0 degrees (the neutral position) and at 30, 60, 90, and 120 degrees of shoulder abduction. In addition, the angle between the long axis of the thoracic spine and medial border of the scapula was measured and compared with the patients' contralateral shoulder.
Of interest is that the authors tracked the change in position and orientation of the scapula without the use of elaborate sensors attached to the bone, but rather with plain radiographs. While the authors concluded "The pattern of scapular position after RTSA, was found to differ from that of the contralateral shoulder, and showed a more scapular upward rotation," when I replotted their data from their Table II, I was impressed at how similar the motion patterns were, with somewhat greater ST motion in the reverse than in the contralateral shoulder:

It is always of interest to view radiographs of reverse total shoulders.
Here's one showing notching and some heterotopic bone formation. We're fortunate that shoulders forgive these happenings.

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