Patients Undergoing Total Shoulder Arthroplasty on the Dominant Extremity Attain Greater Postoperative ROM

Abstract

Background Total shoulder arthroplasty (TSA) provides excellent functional outcomes and pain relief in appropriately selected patients. Although it is known to affect other shoulder conditions, the role of hand dominance after TSA has not been reported, to our knowledge. Questions/Purposes We asked: (1) Does TSA of the dominant arm result in greater postoperative ROM compared with TSA of the nondominant arm? (2) Does hand dominance affect validated outcome scores after TSA? Methods We performed a review of all patients who underwent primary TSAs between 2008 and 2011 with a minimum of 12 months followup. During that time, one surgeon performed 156 primary TSAs. One hundred twenty-seven patients met the minimum followup requirement for this analysis (81%), whereas 29 (19%) were lost to followup. Seven patients were excluded for surgical indications other than glenohumeral osteoarthritis. A total of 58 patients underwent TSA of the dominant upper extremity and 62 underwent TSA of the nondominant upper extremity. Patient demographics, preoperative and postoperative ROM, and preoperative and postoperative outcome scores, were collected from the medical records. Student's t-tests and chi-square tests were used for analysis. Demographics and preoperative ROM did not differ between patients undergoing TSA on the dominant or the nondominant upper extremity.Results Dominant-arm TSAs showed greater postoperative forward elevation and external rotation. Postoperative active forward elevation in the dominant group was 151°v ersus 141°in the nondominant group (mean difference, 10°; 95% CI, 1°-18°; p = 0.033). Postoperative active external rotation was 61°in the dominant group, versus 51°i n the nondominant group (mean difference, 10°; 95% CI, 5°-15°; p \ 0.001). Active internal rotation did not differ (dominant, 52°, nondominant, 50°; mean difference, 2°;

Clinical Importance of Graft Integrity in Arthroscopic Superior Capsular Reconstruction Using a Minimally Invasively Harvested Midthigh Fascia Lata Autograft: 3-Year Clinical and Magnetic Resonance Imaging Outcomes

“…The clinical outcomes improved significantly from preoperatively to 3 years postoperatively, with sufficiently large and consistent differences that were also clinically important because they were higher than the minimal clinically important difference determined for patients who are Measured as the highest vertebral body that the patient's thumb could reach without pain: lateral thigh = 0, buttock = 1, sacrum = 2, lumbar = 3, T12 = 4, and T7 = 5. treated for rotator cuff disease. The minimal clinically important difference, defined as the smallest change in an outcome that signifies an important improvement in a symptom, is 10°for active elevation, 9 10.4 points for the CS, 26 and 2 points for the SST 46 in patients treated for rotator cuff disease. Most clinical outcomes did not change significantly from 2 to 3 years; however, the mean improvement in active abduction was statistically significant, and this difference was the largest and most consistent among the clinical outcomes measured during this period of time.…”

Effect of Hand Dominance on Range of Motion and Outcomes Following Reverse Total Shoulder Arthroplasty

“…While there is not a set minimal clinical significant difference for shoulder ROM, previous studies suggested 10° to be clinically significant. 19 Our preoperative difference of 20° in FE and ABD between DO and ND groups appears to significantly impact patients as evidenced by their subjective rating. A recently published article described a minimal clinical significant difference of 9 points and a substantial clinical benefit of 23 points on the ASES score.…”

“…LeBlanc et al 17 found poorer outcomes in the dominant extremity when a hemiarthroplasty was performed for proximal humerus fractures. Conversely, Cvetanovich et al 19 found that dominant shoulders attain increased FE compared to their nondominant cohort when an anatomic TSA was performed. In our study, which focused on rTSA, we found the contrary-that patients who had rTSA performed on their ND extremity had a higher increase in FE and ABD than their DO cohorts.…”

Reverse Shoulder Arthroplasty for Patients with Massive Rotator Cuff Tears or Cuff Tear Arthropathies at a Minimum Follow-up of 7 Years

“… 15 Treatment of the dominant arm has also been suggested to yield better functional outcomes after RSA, although clinical outcome scores were not affected by arm dominance. 16 …”