Tuesday, March 11, 2014

Subscapularis and shoulder arthroplasty

Analysis of subscapularis integrity and function after lesser tuberosity osteotomy versus subscapularis tenotomy in total shoulder arthroplasty using ultrasound and validated clinical outcome measures.

These authors proposed to compare subscapularis tenotomy and lesser tuberosity osteotomy —for takedown of the subscapularis during total shoulder arthroplasty.

The subscapularis peel was performed by one surgeon and the lesser tuberosity osteotomy by another.  The tenotomy was repaired using 3 sutures with one suture in the rotator interval. In that this was not a randomized study, there may have been more differences between the two groups and between the surgical technique than just the management of the subscapularis. 

They used physical examination parameters, outcome measures, and ultrasonography to determine whether the 2 techniques of subscapularis mobilization have different outcomes at a minimum of 1 year after surgery. 

One of 28 lesser tuberosity osteotomies was radiographically non-united. 
Four of 32 subscapularis tenotomies had abnormal ultrasounds (3 thinned and one ruptured). Abnormal subscapularis tendons identified by ultrasonography correlated with clinically inferior functional outcome scores. The authors concluded that they identified no clinically significant differences between the two techniques.

Comment: This study suggests again that the integrity of the subscapularis is important to the result of shoulder arthroplasty. 

Our management of the subscapularis is shown here. The tenotomy is repaired using six sutures carefully placed in the lateral margin of the tendon and capsule. After surgery it is critical to care for the subscapularis.

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