IntroductionThe deltoid muscle plays an essential role for the postoperative functional outcome after reverse shoulder arthroplasty. Ultrasound elastography is areliable method for detecting soft tissueproperties and their changes due to different conditions or pathologies. Tissue stiffness is calculated after application of an acoustic impulse (acoustic radiation force impulse, ARFI), which deforms the underlying tissue. The purpose of this study was to evaluate changes in the deltoid muscle tissue after RSA and reveal a correlation to the functional outcome.Material and methods18 patients treated with reserve shoulder arthroplasty after proximal humeral fracture or cuff arthropathy were included. Shear wave elastography was performed on both sides of three regions of the deltoid muscle. Functional outcome was recorded by VAS, CMS, range of motion and strength (flexibar). Statistical analysis was performed by SPSS.ResultsThe functional outcome was satisfactory (VAS pain: 18 points, VAS function: 64 points, Constant Murley: 66 points). Force was reduced to 48.8N after RTSA in comparison to 58.3 N on the healthy side (p> 0.07). SWE was able to show a higher overall muscle tension of the deltoid in patients after RSA compared to the contralateral non-operated side. The differences were particularly visible in the anterior and middle deltoid region. Under isometric load all deltoid regions showed significantly increased tension, which was particularly eminent in the anterior region of the pars clavicularis.ConclusionShear wave elastography is a reliable method for detecting changes of tension in the deltoid muscle after RTSA and shows a higher tension of all areas of the deltoid, especially prominent in the anterior and middle portion of the deltoid. Future application possibilities are monitoring of deltoid vitality, preoperative assessment and intraoperative management.Level of evidence: diagnostic study, Level III