Saturday, March 16, 2013

Preserve the subscapularis in total shoulder arthroplasty

Importance of the subscapularis muscle after total shoulder arthroplasty.

This is a very interesting paper. These authors tested the hypothesis that a deficient subscapularis following total shoulder arthroplasty can induce joint instability. They developed an EMG-driven musculoskeletal model of the glenohumeral joint based on an algorithm that minimizes the difference between measured and predicted muscular activities, while satisfying the mechanical equilibrium of the glenohumeral joint. 

With abduction in the plane of the scapula, a deficient subscapularis induced a decrease of the force of the infraspinatus muscle. This force decrease was balanced by an increase of the supraspinatus and middle deltoid. As a consequence, the deficient subscapularis induced an upward migration of the humeral head, an eccentric contact pattern and higher stress within the cement.

This is quite interesting in that shoulder surgeons are recognizing the role that delayed superior instability plays in failure of total shoulder arthroplasty.

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