Loss of subscapularis function after total shoulder replacement: A seldom recognized problem

Miller, Suzanne L.; Hazrati, Yassamin; Klepps, Steven; Chiang, Alexis S.; Flatow, Evan L.

doi:10.1067/mse.2003.128195

Cited by 217 publications

(210 citation statements)

References 9 publications

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“…In agreement with Greiner et al [14], we confirm the correlation (although moderate, À0.496 to À0.600) between higher grades of fatty degeneration of the subscapularis and inferior clinical results [7,18,26]. Our study differs from the study of Gerber et al [12] in that their followup was 39 months versus 18 months for our patients, and there was one supervising surgeon in their study versus one surgeon in ours, but these differences do not preclude comparison of the preoperative (Table 6) or postoperative results (Table 7).…”

Section: Discussionsupporting

confidence: 92%

“…Our study has several limitations. First, although ultrasound is reliable in diagnosing subscapularis tendon tears [19,26,30,35], we performed no sonographic investigation to confirm the integrity of the subscapularis tendon. CT is not accurate enough to evaluate the tendon.…”

Section: Discussionmentioning

confidence: 99%

“…Despite more reliable subscapularis tendon reattachment, degeneration of the subscapularis muscle after open surgical release remains a concern [12,20,26,29,36]: fatty infiltration of the subscapularis muscle progresses by at least one stage in 45% of cases postoperatively [12]. Fatty muscular degeneration negatively influences strength, mobility, and overall Constant-Murley scores [7,12].…”

mentioning

confidence: 99%

“…Fatty muscular degeneration negatively influences strength, mobility, and overall Constant-Murley scores [7,12]. The reason for progression of fatty infiltration of the subscapularis muscle is unknown, but denervation during surgical approach has been suggested [26]. Muscular damage during surgical approach with release and mobilization of the subscapularis muscle also may explain the degeneration [28].…”

mentioning

confidence: 99%

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Subscapularis Release in Shoulder Replacement Determines Structural Muscular Changes

Wilde

Coninck

Neve

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Osteotomy of the lesser tuberosity in shoulder arthroplasty allows bony healing of the subscapularis tendon but does not prevent fatty degeneration in its muscle. Occurrence or increase in fatty degeneration may depend on the surgical technique. Questions/purposes We (1) assessed fatty degeneration in the subscapularis muscle and its cross-sectional area after a C-block osteotomy of the lesser tuberosity with minimal mobilization of the subscapularis muscle, and (2) determined whether this technique had any adverse effect on function, fatty degeneration, and cross-sectional area of the subscapularis muscle. Methods We retrospectively examined 36 patients with shoulder replacements who had C-block osteotomies. Constant-Murley scores and clinical signs of subscapularis insufficiency were recorded. We radiographically assessed prosthetic placement. On CT scans, lesser tuberosity healing, fatty degeneration, and cross-sectional area of the subscapularis muscle were determined. The minimum followup was 13 months (mean, 18 months; range, 13-33 months).

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Subscapularis Release in Shoulder Replacement Determines Structural Muscular Changes

Wilde

Coninck

Neve

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…After total shoulder arthroplasty (TSA), a dysfunction of the subscapularis (SC) muscle has been reported to be higher than 60% (Miller et al, 2003). It is assumed that the SC muscle deficiency can reduce the stability of the joint and the life span of the prosthesis.…”

Section: Introductionmentioning

confidence: 99%

Importance of the subscapularis muscle after total shoulder arthroplasty

Terrier

Larrea

Camine

et al. 2013

Clinical Biomechanics

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Background: The rotator cuff muscles are the main stabilizer of the glenohumeral joint. After total shoulder arthroplasty using anterior approaches, a dysfunction of the subscapularis muscle has been reported. In the present paper we tested the hypothesis that a deficient subscapularis following total shoulder arthroplasty can induce joint instability. Methods: To test this hypothesis we have developed an EMG-driven musculoskeletal model of the glenohumeral joint. The model was based on an algorithm that minimizes the difference between measured and predicted muscular activities, while satisfying the mechanical equilibrium of the glenohumeral joint. A movement of abduction in the scapular plane was simulated. We compared a normal and deficient subscapularis. Muscle forces, joint force, contact pattern and humeral head translation were evaluated. Findings: To satisfy the mechanical equilibrium, a deficient subscapularis induced a decrease of the force of the infraspinatus muscle. This force decrease was balanced by an increase of the supraspinatus and middle deltoid. As a consequence, the deficient subscapularis induced an upward migration of the humeral head, an eccentric contact pattern and higher stress within the cement. Interpretation: These results confirm the importance of the suscapularis for the long-term stability of total shoulder arthroplasty.

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Subscapularis tendon tears: A common sonographic finding in symptomatic postarthroplasty shoulders

Ives

Nazarian

Parker

et al. 2012

J of Clinical Ultrasound

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Loss of subscapularis function after total shoulder replacement: A seldom recognized problem

Cited by 217 publications

References 9 publications

Subscapularis Release in Shoulder Replacement Determines Structural Muscular Changes

Subscapularis Release in Shoulder Replacement Determines Structural Muscular Changes

Importance of the subscapularis muscle after total shoulder arthroplasty

Subscapularis tendon tears: A common sonographic finding in symptomatic postarthroplasty shoulders

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