Subscapularis Release in Shoulder Replacement Determines Structural Muscular Changes

Wilde, Lieven F. De; Coninck, Tineke De; Neve, Francis De; Berghs, Bart

doi:10.1007/s11999-012-2291-x

Cited by 29 publications

(21 citation statements)

References 35 publications

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“…This approximation was supported by an EMG study comparing healthy subjects to rotator cuff tear patients and reporting no significant differences in inter-muscular coordination (Hawkes et al, 2012). We associated muscular deficiency with PCSA, as suggested by clinical observations (De Wilde et al, 2012;Goutallier et al, 1994). The PCSA decrease was set to 50% as a first estimate, but in a next step this value will be measured directly on the patient CT.…”

Section: Discussionsupporting

confidence: 76%

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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Section: Discussionsupporting

confidence: 76%

Importance of the subscapularis muscle after total shoulder arthroplasty

Terrier

Larrea

Camine

et al. 2013

Clinical Biomechanics

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“…Several studies have examined subscapularis healing rates with an intact tendon repair and concomitant increased muscle fatty infiltration 4, 8, 12. De Wilde et al 5 retrospectively examined 36 patients after lesser tuberosity osteotomy, with a 100% healing rate and a 13% decrease in the cross-sectional area of the subscapularis muscle at an average of 18 months (range, 13-33 months) of follow-up. This finding suggests an alternative pathophysiology for the subscapularis abnormalities noted after anatomic total shoulder arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Innervation of the subscapularis: an anatomic study

et al. 2019

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Background Successful healing of the subscapularis during anatomic total shoulder arthroplasty surgery is critical to optimize functional outcomes and avoid complications. The purpose of this study was to examine the upper and lower subscapularis nerve insertion in relation to the musculotendinous junction to estimate the risk of nerve injury. Our hypothesis was that arm position changes the risks to these nerves when exposing the anterior glenoid. Methods Twenty cadaveric shoulders were dissected, and the subscapular nerves were identified from the posterior cord of the brachial plexus to the muscle insertion. The nerve length from the origin to the muscle insertion and the distance to the myotendinous junction were measured in various shoulder positions including neutral, external, and internal rotation. Results The mean length of the upper subscapular nerve was 51.4 ± 12.8 mm; that of the lower subscapular nerve was 50.5 ± 14 mm. The mean distance from the insertion of the upper subscapular nerve to the myotendinous junction 53.0 ± 14.7 mm with external rotation, 38.5 ± 9.7 mm with neutral rotation, and 30.0 ± 9.2 mm with internal rotation. The mean distance from the lower subscapular nerve to the myotendinous junction was 44.5 ± 13.8 mm with external rotation, 31.9 ± 9.3 mm with neutral rotation, and 25.4 ± 8.8 mm with internal rotation. The internally rotated position placed these nerves closest to the glenohumeral joint. Conclusion The upper and lower subscapular nerves insert in the muscle belly close to the myotendinous junction, putting them at risk of iatrogenic injury. Care must be taken to avoid damage with retractor placement in the anterior glenoid neck as these nerves are at risk of compression or torsional injury.

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“…In this series, we have not correlated the radiological appearances with clinical outcomes. However, the clinical results after LTO repair that result in bony union are well described and, other than the technique of suture passage and suture management, there is no significant difference in our technique to that described elsewhere . Therefore, it appears unlikely that our technique would adversely affect rates of atrophy, fatty infiltration or denervation and hence clinical outcomes would be expected to be similar.…”

Section: Discussionmentioning

confidence: 81%

The ‘Modified Union Jack’ Repair of a Lesser Tuberosity Osteotomy in Total Shoulder Arthroplasty: Surgical Technique and Radiological Results

2013

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Background Several different techniques have been described for repairing a lesser tuberosity osteotomy in shoulder arthroplasty, although all have potential drawbacks. We describe a novel repair technique and its radiological results. Methods All patients undergoing a total shoulder arthroplasty using a resurfacing humeral component from 2008 to date were identified retrospectively. Anteroposterior (AP) and axial radiographs at a minimum of 3 months postoperatively were used to assess union of the osteotomy fragment. Results Seventy‐six total shoulder replacements in 65 patients were eligible for review. Seven were excluded as a result of inadequate radiographs. Sixty‐six of 69 had united (95.6%). There were two cases (2.9%) of a complete non‐union that was undisplaced. In one patient (1.4%), the osteotomy fragment had displaced and this was apparent on the initial postoperative AP radiograph. Conclusions The modified union jack repair technique is simple, fast, economical and reliable.

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Subscapularis Release in Shoulder Replacement Determines Structural Muscular Changes

Cited by 29 publications

References 35 publications

Importance of the subscapularis muscle after total shoulder arthroplasty

Importance of the subscapularis muscle after total shoulder arthroplasty

Innervation of the subscapularis: an anatomic study

The ‘Modified Union Jack’ Repair of a Lesser Tuberosity Osteotomy in Total Shoulder Arthroplasty: Surgical Technique and Radiological Results

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