Soft Tissue Management in Shoulder Arthroplasty

Custom, 3-Dimensional Patient-Specific Instrumentation in Anatomic Total Shoulder Arthroplasty: Part 2, Dissection and Soft Tissue Management

“… 16 , 17 , 18 Tenodesis of the LHB is usually performed by suturing the detached biceps tendon to the pectoralis major tendon. 19 Isolated tenotomy is an option with the same functional outcomes as tenodesis, however, can lead to persistent cramping and cosmetic deformity. 20 …”

Update on Shoulder Arthroplasties with Emphasis on Imaging

“…The deltoid exerts a superior force to abduct and elevate the humerus [2]. The force couples of the rotator cuff muscles and deltoid are balanced [5]. With large and massive rotator cuff tears, there is disruption of the force couple balance, with loss of the fulcrum, eventually leading to superior migration of the humerus and pseudo-paralysis [5].…”

“…Intraoperatively, subscapularis tenotomy, subscapularis peel, or lesser tuberosity osteotomy are often performed to access the glenohumeral joint via a deltopectoral approach, making the subscapularis tendon susceptible to post-operative tearing [2,14,39]. Inadequate healing of the subscapularis tendon as well as subscapularis tears can result in pain, anterior instability, loss of function, and in some cases, loosening of the glenoid component due to abnormal forces; thus, proper repair of the subscapularis tendon is essential to arthroplasty longevity and avoidance of revision [5,26,39,53,54]. A subscapularis-sparing surgical approach through the rotator interval may help reduce post-operative subscapularis failure in certain patient populations.…”

“…If a cuff tear occurs in an ATSA, the humeral head is no longer centered on the glenoid, resulting in increased forces along the glenoid component and polyethylene wear. The resulting repetitive eccentric loading of the glenoid with humeral head movement produces a rocking-horse mechanism of glenoid component loosening [5,55]. Dislocation following ATSA is often secondary to rotator cuff deficiency, coracoacromial arch insufficiency, humeral component malrotation, glenoid dysfunction, and capsular failure [16].…”

“…It is fixed via a central screw that provides compression and is reinforced with locking screws peripherally. The glenosphere (4) attaches to the glenoid baseplate/metaglene via an eccentric Morse taper (5) to allow for distalization of the components and minimize scapular notching.…”