Applied anatomical study on suprascapular nerve protection in reverse total shoulder arthroplasty

Li, Jianfeng; Zhou, Junlin; Wang, Dong; Li, Dacun; Zhang, Wentong

doi:10.1186/s13018-020-02061-2

Cited by 6 publications

(3 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A retrospective study of patients who underwent reverse total shoulder arthroplasty was reported to have 12% risk of iatrogenic suprascapular nerve neuropathy by Jang et al [8]. The distance between the nearest point of the nerve and the osteotomy plane of 15.38 mm was found by Li et al [11]. This is important for base size selection while performing shoulder arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Internal rotation of the shoulder in the beach chair position may increase the risk of iatrogenic suprascapular nerve injury at the spinoglenoid notch during surgical treatment for shoulder instability

Promsang

Limskul

Moonwong

et al. 2022

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

PurposeSuprascapular nerve (SN) at the spinoglenoid notch is a mobile structure which is vulnerable to iatrogenic injury from screw or guidewire penetration during shoulder surgery such as Latarjet procedure or SLAP/Bankart repairs. The primary objective is to identify the distance between posterior glenoid and SN in different shoulder abduction and rotation. The secondary objective is to identify the distance in standard lateral decubitus position. MethodsNineteen shoulders from 10 Thiel embalmed soft cadavers were used in this study. The dissection of posterior shoulder was done to identify the SN at spinoglenoid notch. The distance between the posterior glenoid rim and the SN was measured. In beach chair position, the SN distance from six combinations of shoulder position was obtained: adduction/90° internal rotation (ADIR), adduction/neutral rotation (ADN), adduction/90° external rotation (ADER), 45° abduction/90° internal rotation (ABIR), 45° abduction/neutral rotation (ABN), 45° abduction/90° external rotation (ABER). Subsequently, the suprascapular nerve distance was measured in standard lateral decubitus position with 10 lbs. longitudinal traction. ResultsIn the beach chair position with the shoulder in adduction, the mean distances between the glenoid and the SN in ADIR, ADN and ADER were 15.0 ± 3.3, 19.3 ± 2.6 and 19.5 ± 3.1 mm, respectively. During shoulder abduction, the mean distances when the shoulder was in ABIR, ABN and ABER were 15.2 ± 3.4, 19.4 ± 3.0 and 19.3 ± 2.6 mm, respectively. The mean distance for the lateral decubitus position was 19.3 ± 2.4 mm. The distance between the glenoid and SN was significantly shorter when the shoulder was positioned in internal rotation than in neutral (p < 0.001) or external rotation (p < 0.001) when compared to the same shoulder abduction position. The lateral decubitus position had comparable SN distance with the shoulder position of abduction/neutral rotation in beach chair position. ConclusionThe SN was closest to posterior glenoid rim if the shoulder was in internal rotation. Therefore, shoulder internal rotation must be avoided during guidewire and cannulated screw placement in the Latarjet procedure and drill bit insertion during anchor placement in SLAP/Bankart repair.

show abstract

Section: Discussionmentioning

confidence: 99%

Internal rotation of the shoulder in the beach chair position may increase the risk of iatrogenic suprascapular nerve injury at the spinoglenoid notch during surgical treatment for shoulder instability

Promsang

Limskul

Moonwong

et al. 2022

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

show abstract

“…Also, if superior and posterior screws penetrate the scapular spine, they can act as stress risers and lead to scapular fracture. Therefore, the length and direction of superior and posterior screws should be checked carefully [21][22][23]. An oval-shaped baseplate could be better for fixation, but it can be too large for Asian patients with a relatively smaller-sized glenoid [14,20,24].…”

Section: A a B Bmentioning

confidence: 99%

Implant selection for successful reverse total shoulder arthroplasty

Jeong

Won

2022

Clin Shoulder Elbow

View full text Add to dashboard Cite

Reverse total shoulder arthroplasty (RTSA) emerged as a new concept of arthroplasty that does not restore normal anatomy but does restore function. It enables the function of the torn rotator cuff to be performed by the deltoid and shows encouraging clinical outcomes. Since its introduction, various modifications have been designed to improve the outcome of the RTSA. From the original cemented baseplate with peg or keel, a cementless baseplate was designed that could be fixed with central and peripheral screws. In addition, a modular-type glenoid component enabled easier revision options. For the humeral component, the initial design was an inlay type of long stem with cemented fixation. However, loss of bone stock from the cemented stem hindered revision surgery. Therefore, a cementless design was introduced with a firm metaphyseal fixation. Furthermore, to prevent complications such as scapular notching, the concept of lateralization emerged. Lateralization helped to maintain normal shoulder contour and better rotator cuff function for improved external/internal rotation power, but excessive lateralization yielded problems such as subacromial notching. Therefore, for patients with pseudoparalysis or with risk of subacromial notching, a medial eccentric tray option can be used for distalization and reduced lateralization of the center of rotation. In summary, it is important that surgeons understand the characteristics of each implant in the various options for RTSA. Furthermore, through preoperative evaluation of patients, surgeons can choose the implant option that will lead to the best outcomes after RTSA.

show abstract

“…Studies have shown that rTSA is a feasible and effective method for reconstructing bone defects after tumor resection unless the patient has axillary nerve injury and a nonfunctional deltoid muscle [ 7 – 9 ]. However, some problems remain with the underlying operation, such as complications, scapular notching, the repair of limb bone defects after large-scale tumor resection, and soft-tissue reconstruction after deltoid muscle resection [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Do reverse total shoulder replacements have better clinical and functional outcomes than hemiarthroplasty for patients undergoing proximal humeral tumor resection using devitalized autograft composite reconstruction: a case-control study

Zuo

Yang

et al. 2021

J Orthop Surg Res

View full text Add to dashboard Cite

Objective To compare the efficacy and prognosis of reverse total shoulder arthroplasty (rTSA) with shoulder hemiarthroplasty (SHA) using devitalized autograft or allograft composite reconstruction after proximal humeral tumor resection. Methods We retrospectively reviewed patients who underwent SHA (32) and rTSA (20) for tumor resections of the proximal humerus from January 2014 to July 2020. The clinical results included duration of the operation, intraoperative blood loss, bone union, visual analog scale (VAS) score, shoulder range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) shoulder score, recurrence, and overall survival. Results Fifty-two patients were followed up for a mean of 30 months. Thirty-two patients were SHA with allograft-prosthetic composite (APC) reconstructions, while other 20 were rTSA with devitalized autograft-prosthetic composite reconstructions. At the end of the follow-up, 2 recurrence, 3 postoperative infections, and 4 subluxations occurred among the SHA patients. Two patients in the rTSA group had postoperative anterior dislocation and underwent revision surgery with surgical mesh, and 2 (2/20) had grade II scapular notching. The mean VAS score of the shoulder was 1.5 ± 0.8 in the rTSA group and 2.3 ± 1.2 in the SHA group (p < 0.05). The mean active forward flexion of the shoulder joint was 50.6 ± 6.0 in the SHA group and 100 ± 7.6 in the rTSA group (p < 0.05). The ASES shoulder score was 78 ± 3.0 in the rTSA group and 52 ± 5.6 in the SHA group (p < 0.05). The overall 3-year survival rate of all patients was 60.0%, and patients in the rTSA group showed better survival in terms of the mean 3-year OS than patients in the SHA group (p = 0.04). Conclusion rTSA with devitalized autograft-prosthetic composite can offer a reasonable reconstruction of the shoulder joint after Malawer type I tumor resection. Compared with patients who underwent SHA, patients who underwent rTSA present good outcomes, a better range of motion, better bone union, and no increase in instability rate in the mid-term.

show abstract

Applied anatomical study on suprascapular nerve protection in reverse total shoulder arthroplasty

Cited by 6 publications

References 26 publications

Internal rotation of the shoulder in the beach chair position may increase the risk of iatrogenic suprascapular nerve injury at the spinoglenoid notch during surgical treatment for shoulder instability

Internal rotation of the shoulder in the beach chair position may increase the risk of iatrogenic suprascapular nerve injury at the spinoglenoid notch during surgical treatment for shoulder instability

Implant selection for successful reverse total shoulder arthroplasty

Do reverse total shoulder replacements have better clinical and functional outcomes than hemiarthroplasty for patients undergoing proximal humeral tumor resection using devitalized autograft composite reconstruction: a case-control study

Contact Info

Product

Resources

About