Background: Internal rotation limitation is prevalent following modern reverse shoulder arthroplasty and negatively affects patients' subjective rating of the procedure. Internal rotation limitation after reverse total shoulder is common (41% of patients can only reach to sacrum level or worse) and negatively affects patient satisfaction. IR limitation is an independent factor associated with lower patient rating after RSA. Most research has been focused on implant geometry (lateralization, glenosphere position/size, NSA, version) with limited success.
The Journal Club Article:
Conjoint tendon release results in improvedinternal rotation and pain following reverse shoulder arthroplasty: a combined randomized clinical trial and biomechanical study included a level I RCT (55 patients) plus biomechanical validation (6 cadaveric specimens) study of Z-plasty release of conjoint tendon 2 cm distal to coracoid.
In the clinical study, the released shoulders showed a modest improvement in reach up the back and lessening in pain, but these differences were not clinically significant (MCID for pain score = 1.5). There was no difference in the ASES score between the groups.
In the cadaveric study, the increases in internal rotation and extension were statistically significant but less than 10°. The force to subluxate was decreased by 4.3 N.
Conclusion: While internal rotation deficits are common and problematic after RSA, in this study the improvements in internal rotation after conjoint tendon release were modest and did not provide clinically significant improvement for the patients.
It has been previously noted that function-specific patient reported outcomes, such as the Simple Shoulder Test, are more sensitive than global PROs in detecting internal rotation deficits after reverse total shoulder arthroplasty. It has also been documented that the ability to reach up the back (not a strictly rotational measure) is heavily influenced by the range of shoulder extension.
See:
Factors influencing functional internal rotation after reverse total shoulder arthroplasty
Takeaway: conjoint tendon release may be considered when performing RSA if extension is limited
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Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link)
The total shoulder arthroplasty (see this link)
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link)
