Factors influencing functional internal rotation after reverse total shoulder arthroplasty

Hochreiter, Bettina; Hasler, Anita; Hasler, Julian; Kriechling, Philipp; Borbas, Paul; Gerber, Christian

doi:10.1016/j.jseint.2021.03.005

Cited by 32 publications

(12 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In view of the controversial data in the literature, 5,6,8,18,35 it was interesting to document that good fIR is possible despite severe FI of the subscapularis, provided that extension and internal rotation in extension are unrestricted. Functional internal rotation accounts for roughly 10% of the rCS and SSV 31 and is therefore relevant to the quality of life of an individual.…”

Section: Discussionmentioning

confidence: 99%

“…17,31 Functional internal rotation is quantified by the Constant-Murley score (CS) with anatomic landmarks that can be reached with the thumb. 3 Restoration of fIR accounts for approximately 10% of the total outcome, 18 and loss of fIR can be disabling for activities of daily living (ADLs) such as toileting, pulling up pants or a skirt, or tucking a shirt into pants. 21,37,38,42 Historically, shoulder surgeons have focused on restoring active elevation, abduction, and external rotation after reverse total shoulder arthroplasty (RTSA).…”

mentioning

confidence: 99%

“…The interpretation of their findings, however, does not explain the clinical loss of fIR after RTSA. 18,39 Although in the normal shoulder, an average extension of 60 seems to be required for many ADLs behind the back, 31 the hypothesis that a lack of extension could be coresponsible for poor fIR has not yet been tested, even though a computer-model study of RTSA has shown that bony impingement can already occur at 1 of extension and thereby limit mobility. 20 Therefore, the purpose of this study was to examine active shoulder extension after RTSA.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Extension of the shoulder is essential for functional internal rotation after reverse total shoulder arthroplasty

Hochreiter¹,

Wyss²,

Gerber³

2022

Journal of Shoulder and Elbow Surgery

Self Cite

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Extension of the shoulder is essential for functional internal rotation after reverse total shoulder arthroplasty

Hochreiter¹,

Wyss²,

Gerber³

2022

Journal of Shoulder and Elbow Surgery

Self Cite

View full text Add to dashboard Cite

“…by shifting the relationship between the glenohumeral joints and shifting the center of rotation downward. Although the requirement for rotator cuff integrity is lower than that of HA, the integrity of the greater tuberosity still has a significant effect on shoulder function after RSA (37). Additionally, RSA also has various complications such as periprosthetic fractures and shoulder loosening or dislocation (38).…”

Section: Discussionmentioning

confidence: 99%

Reverse shoulder arthroplasty vs. hemiarthroplasty for the treatment of osteoporotic proximal humeral fractures in elderly patients: A systematic review and meta‑analysis update

Han

Wang

et al. 2022

Exp Ther Med

View full text Add to dashboard Cite

The present meta-analysis was conducted to compare the safety and effectiveness of reverse shoulder arthroplasty (RSA) and hemiarthroplasty (HA) in the treatment of osteoporotic proximal humeral fractures in elderly patients. The Embase, Pubmed Central, Cumulative Index to Nursing and Allied Health Literature, ProQuest Dissertations and Theses, Cochrane Library and Chinese Biomedical databases were searched between January 2009 and January 2022 to identify relevant studies. According to the search strategy, a total of 210 associated studies were retrieved and 16 were finally included. Review Manager 5.4 software was used for the data analysis. This study indicated that patients in the RSA group had significantly improved treatment outcomes compared with patients in the HA group, as assessed by Constant-Murley Shoulder Outcome Score (95% CI, 1.69-3.76; P<0.001), American Shoulder and Elbow Surgeons score (95% CI, 11.81-24.88; P<0.001) and shoulder range of motion (ROM; 95% CI, 3.41-9.07; P<0.001). However, the HA group was superior to the RSA group in terms of the Oxford Shoulder score (95% CI, 2.89-11.11; P<0.001). There was no significant statistical difference between the two groups in terms of the Disabilities of the Arm, Shoulder and Hand score and complications. Overall, for the treatment of osteoporotic proximal humeral fractures in the elderly, the RSA group had improved postoperative ROM and functional scores compared with the HA group, without significant difference in the incidence of complications. However, HA remains a safe and reliable treatment option.

show abstract

“…The nonanatomic design manipulates glenohumeral relationships via positioning and orientation of the glenosphere and humeral components [11,36], altering the moment arms of the deltoid and intact rotator cuff musculature [15,17,38]. Although rTSA reliably restores arm elevation, patients often experience limited internal and external rotation [8,18]. Clinical studies commonly report peak active and passive humerothoracic ROM, patient-reported outcomes, and occasionally isometric strength, but not the underlying scapulothoracic and glenohumeral contributions to shoulder motion [8,41].…”

Section: Introductionmentioning

confidence: 99%

Reverse Total Shoulder Arthroplasty Alters Humerothoracic, Scapulothoracic, and Glenohumeral Motion During Weighted Scaption

Sulkar

Aliaj

Tashjian

et al. 2022

Clin Orthop Relat Res

View full text Add to dashboard Cite

BackgroundReverse total shoulder arthroplasty (rTSA) typically restores active arm elevation. Prior studies in patients with rTSA during tasks that load the arm had limitations that obscured underlying three-dimensional (3D) kinematic changes and the origins of motion restrictions. Understanding the scapulothoracic and glenohumeral contributions to loaded arm elevation will uncover where functional deficits arise and inform strategies to improve rTSA outcomes.Questions/purposesIn a cohort of patients who had undergone rTSA and a control cohort, we asked: (1) Is there a difference in maximum humerothoracic elevation when scapular plane elevation (scaption) is performed with and without a handheld weight? (2) Is maximum humerothoracic elevation related to factors like demographics, patient-reported outcome scores, isometric strength, and scapular notching (in the rTSA group only)? (3) Are there differences in underlying 3D scapulothoracic and glenohumeral motion during scaption with and without a handheld weight?MethodsTen participants who underwent rTSA (six males, four females; age 73 ± 8 years) were recruited at follow-up visits if they were more than 1 year postoperative (24 ± 11 months), had a BMI less than 35 kg/m2 (29 ± 4 kg/m2), had a preoperative CT scan, and could perform pain-free scaption. Data from 10 participants with a nonpathologic shoulder, collected previously (five males, five females; age 58 ± 7 years; BMI 26 ± 3 kg/m2), were a control group with the same high-resolution quantitative metrics available for comparison. Participants in both groups performed scaption with and without a 2.2-kg handheld weight while being imaged with biplane fluoroscopy. Maximum humerothoracic elevation and 3D scapulothoracic and glenohumeral kinematics across their achievable ROM were collected via dynamic imaging. In the same session the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST), and isometric strength were collected. Data were compared between weighted and unweighted scaption using paired t-tests and linear mixed-effects models.ResultsWhen compared with unweighted scaption, maximum humerothoracic elevation decreased during weighted scaption for patients who underwent rTSA (-25° ± 30°; p = 0.03) but not for the control group (-2° ± 5°; p = 0.35). In the rTSA group, maximum elevation correlated with the ASES score (r = 0.72; p = 0.02), and weighted scaption correlated with BMI (r = 0.72; p = 0.02) and the SST (r = 0.76; p = 0.01). Scapular notching was observed in three patients after rTSA (Grades 1 and 2). Four of 10 patients who underwent rTSA performed weighted scaption to less than 90° humerothoracic elevation using almost exclusively scapulothoracic motion, with little glenohumeral contribution. This manifested as changes in the estimated coefficient representing mean differences in slopes in the humerothoracic plane of elevation (-12° ± 2°; p < 0.001) and true axial rotation (-16° ± 2°; p < 0.001), scapulothoracic upward rotation (7° ± 1°; p < 0.001), and glenohume...

show abstract

Factors influencing functional internal rotation after reverse total shoulder arthroplasty

Cited by 32 publications

References 49 publications

Extension of the shoulder is essential for functional internal rotation after reverse total shoulder arthroplasty

Extension of the shoulder is essential for functional internal rotation after reverse total shoulder arthroplasty

Reverse shoulder arthroplasty vs. hemiarthroplasty for the treatment of osteoporotic proximal humeral fractures in elderly patients: A systematic review and meta‑analysis update

Reverse Total Shoulder Arthroplasty Alters Humerothoracic, Scapulothoracic, and Glenohumeral Motion During Weighted Scaption

Contact Info

Product

Resources

About