|
Year |
2007 |
|---|---|
|
Question Number |
27 |
|
Category |
Shoulder and Elbow |
Question
Which of the following is the most significant rehabilitation limitation after total shoulder arthroplasty?
1- Deltoid insertion release required for exposure
2- Detachment of the subscapularis
3- Capsular repair
4- Porous ingrowth material on the surface of the device
5- Pectoralis major reattachment
Figures
Answer (click for answer)
The answer is 2- Detachment of the subscapularis
Detachment of the subscapularis is necessary to provide exposure of both the humeral head and the glenoid in primary TSA. The subscapularis tendon lies directly apposed to the anterior capsule of the shoulder and dissecting it cleanly away from anterior capsule for later stout repair can be challenging. A clean dissection and preservation of the subscapularis tendon with a 2-3 mm cuff of tendon left behind at its insertion for later repair is required to provide meaningful internal rotation function. Loss of internal rotation strength (indicated on physical exam by + belly-press test/inability to reach to lower thoracic spine levels) is a significant complication of TSA resulting in functional limitations in activities of daily living as well as increased risk of instability. Detachment of the subscapularis during the procedure therefore leads to the most significant rehab limitation including avoidance of excessive passive external rotation as well as avoiding active internal rotation–as these maneuvers would lead to potential rupture/failure of the subscapularis repair.
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