These authors compared reverse shoulder arthroplasty (RSA) with and without Latissimus dorsi (LD) and teres major (TM) tendon transfers in patients with rotator cuff tear arthropathy and combined loss of elevation and external rotation (CLEER) in a randomized study with the Activities of Daily Living and External Rotation (ADLER) score 2 years after surgery as the primary outcome measure. Secondary outcome measures included the Disabilities of the Arm, Shoulder and Hand (DASH) score, American Shoulder and Elbow Surgeons (ASES) score, and Simple Shoulder Test (SST) score.
CLEER was diagnosed using the following criteria: (1) loss of active shoulder elevation above 110, (2) a positive Hornblower sign on physical examination, and (3) teres minor fatty infiltration of grade 2 or higher on preoperative magnetic resonance imaging.
All patients received components with 0 mm of lateral glenoid offset. The tendon transfer was secured to the lateral aspect of the proximal humeral metaphysis at the level of the teres minor insertion site through transosseous bone tunnels and tensioned while the arm was held in external rotation.
Resolution of the Hornblower sign occurred postoperatively in 58.3% of patients in the control group and 73.3% of those in the treatment group. Both groups showed significant improvements in the ability to perform activities of daily living requiring active external rotation measured by the ADLER score postoperatively. No significant difference in the ADLER, DASH, ASES, or SST score was found between the 2 groups at final follow-up.
Both groups showed significant improvements in all clinical outcome assessments including functional tasks that require active external rotation.
Only 1 major complication occurred: A patient in the treatment group sustained a prosthetic shoulder dislocation at 3 months postoperatively. This was treated with open reduction and polyethylene exchange, with no subsequent events.
Comment: A recent article, "A method for documenting the change in center of rotation with reverse total shoulder arthroplasty and its application to a consecutive series of 68 shoulders having reconstruction with one of two different reverse prostheses" (see this link) helps understand the effect of a reverse total shoulder on external rotation and the importance of prosthesis design. The authors showed that a reverse medializes the center of rotation
and that the amount of medialization differs among prosthesis designs as shown below.
This is shown nicely in the figure below from Steve Lippitt. (A) is the normal shoulder, (B) shows the relaxation of the residual rotators including the posterior deltoid and remaining cuff) with a lot of medialization (which can weaken external rotation), while (C) shows tensioning of the posterior residual rotators by an implant with less medialization (which can restore external rotation).
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To see a YouTube of our technique for a reverse total shoulder arthroplasty, click on this link.
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How you can support research in shoulder surgery Click on this link.
We have a new set of shoulder youtubes about the shoulder, check them out at this link.
Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
Use the "Search" box to the right to find other topics of interest to you.
This is shown nicely in the figure below from Steve Lippitt. (A) is the normal shoulder, (B) shows the relaxation of the residual rotators including the posterior deltoid and remaining cuff) with a lot of medialization (which can weaken external rotation), while (C) shows tensioning of the posterior residual rotators by an implant with less medialization (which can restore external rotation).
Thus, "East-West" tensioning has the potential for improving active external rotation.
To see a YouTube of our technique for a reverse total shoulder arthroplasty, click on this link.
===
How you can support research in shoulder surgery Click on this link.
We have a new set of shoulder youtubes about the shoulder, check them out at this link.
Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
Use the "Search" box to the right to find other topics of interest to you.
You may be interested in some of our most visited web pages arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
