Sunday, July 17, 2016

Perfusion and stiffness of the deltoid after reverse total shoulder

Dynamic contrast-enhanced ultrasound and elastography assess deltoid muscle integrity after reverse shoulder arthroplasty.

These authors point out that the functioning of a reverse shoulder arthroplasty (RSA) depends on the condition of the deltoid muscle. They studied 64 patients having RSA using postoperative contrast-enhanced ultrasound (CEUS) to assess perfusion and acoustic radiation force impulse (ARFI) to assess elasticity of the deltoid muscle and compared these results with the clinical and functional outcome.

After RSA, they found that deltoid perfusion was inferior compared with the contralateral side. The perfusion deficit was associated with a limited range of motion and poorer clinical outcomes. The deltoid of the operated shoulder showed higher stiffness than the contralateral muscles. EMGs excluded functionally relevant axillary nerve injuries in the study population.

They conclude that functional shoulder impairment after RSA might be predicted by noninvasive CEUS as a measure of the integrity of the deltoid muscle.

Comment: A difficulty with this study is that we cannot be sure what the contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) showed before surgery. If, as the authors suggest, functional shoulder impairment after RSA might be predicted by noninvasive CEUS and ARFI, it would be important to obtain theses studies before surgery to determine how well they predicted the result.

There is another consideration, and that is that the perfusion and stiffness of the deltoid after RSA surgery may be caused by the arm lengthening that may accompany this procedure as shown below and as discussed in this link.

Our approach to reverse total shoulder arthroplasty is shown in this link. We attempt to minimize arm lengthening by avoiding excessive inferior placement and tilt of the glenosphere.


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