Postoperative rupture of the anterolateral deltoid muscle following reverse total shoulder arthroplasty in patients who have undergone open rotator cuff repair

Background: Although recent evidence suggests that any prior shoulder surgery may cause inferior shoulder arthroplasty outcomes, there is no consensus on whether previous rotator cuff repair (RCR) is associated with inferior outcomes after reverse total shoulder arthroplasty (RTSA). Purpose: To retrospectively compare outcomes in patients who underwent RTSA with and without previous RCR. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with prior RCR and those without previous shoulder surgery (control) who underwent RTSA for cuff tear arthropathy or irreparable cuff tear were retrospectively identified from a prospective database. Exclusion criteria included revision arthroplasty, fractures, rheumatoid arthritis, dislocations, infection, prior non-RCR procedures, less than 12 months of follow-up, and latissimus dorsi tendon transfer. The American Shoulder and Elbow Surgeons (ASES) score, ASES Activities of Daily Living (ADL) score, visual analog scale (VAS) score for pain, Subjective Shoulder Value (SSV), and range of motion (ROM) were compared between groups. Results: Patients with previous RCR (n = 83 shoulders) were younger (mean ± SD, 67 ± 10 vs 72 ± 8 years; P < .001) and more likely to be male (46% vs 32%, P = .033) than controls (n = 189 shoulders). No differences were found in follow-up duration (25 ± 13 vs 26 ± 13 months, P = .734), body mass index, or any preoperative outcome variable or ROM measure. At final follow-up, patients with previous RCR had significantly lower ASES (76.5 [95% CI, 71.2-81.7] vs 85.0 [82.6-87.5], P = .015), lower SSV (76 [72-81] vs 86 [83-88], P < .001), worse pain (2.0 [1.4-2.6] vs 0.9 [0.6-1.1], P < .001), and less improvement in the ASES, ASES ADL, VAS, SSV, and forward elevation measures than controls. Multivariable linear regression analysis demonstrated that previous RCR was significantly associated with lower postoperative ASES score ( B = –9.5, P < .001), lower ASES improvement ( B = –7.9, P = .012), worse postoperative pain ( B = 0.9, P = .001), worse improvement in pain ( B = –1.0, P = .011), lower postoperative SSV ( B = –9.2, P < .001), lower SSV improvement ( B = –11.1, P = .003), and lower forward elevation ROM improvement ( B = –12.7, P = .008). Conclusion: Patients with previous RCR attempts may experience fewer short-term gains in functional and subjective outcome scores after RTSA compared with patients with no history of shoulder surgery who undergo RTSA. However, the differences between groups were small and below the minimal clinically important differences for the outcome measures analyzed.

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Effect of deltoid volume on range of motion and patient-reported outcomes following reverse total shoulder arthroplasty in rotator cuff-intact and rotator cuff-deficient conditions

Shoulder & Elbow ◽

10.1177/1758573220925046 ◽

2020 ◽

pp. 175857322092504

Author(s):

Samuel G McClatchy ◽

Griffin M Heise ◽

William M Mihalko ◽

Frederick M Azar ◽

Richard A Smith ◽

...

Keyword(s):

Rotator Cuff ◽

Range Of Motion ◽

Shoulder Arthroplasty ◽

Patient Reported Outcomes ◽

Total Shoulder Arthroplasty ◽

Deltoid Muscle ◽

Reverse Total Shoulder Arthroplasty ◽

Shoulder Range Of Motion ◽

Patient Reported ◽

Reverse Total Shoulder

Background Deltoid muscle function is paramount to the success of reverse total shoulder arthroplasty. The purpose of this study was to investigate the role of deltoid volume on shoulder range of motion and patient-reported outcomes following reverse total shoulder arthroplasty in rotator cuff-intact and rotator cuff-deficient conditions. Methods Retrospective review of records identified 107 patients who met inclusion criteria. The rotator cuff integrity was evaluated by two musculoskeletal-trained radiologists. Volumetric deltoid measurements were calculated from preoperative computed tomography or magnetic resonance imaging scans. Satisfactory outcomes were defined as forward elevation of at least 135°, external rotation of at least 35°, and American Shoulder and Elbow Surgeons and Single Assessment Numerical Evaluation scores of at least 70. Results Mean total deltoid muscle volume was significantly higher in patients with satisfactory forward elevation (57.8 ± 18.1 cm³) versus unsatisfactory forward elevation (48.6 ± 19.5 cm³) (p = 0.013). When separated by rotator cuff integrity, total deltoid volume was significantly higher (p = 0.030) in patients who achieved satisfactory forward elevation in the rotator cuff-deficient group but not the rotator cuff-intact group (p = 0.533). Discussion Preoperative deltoid volume directly correlated with achieving satisfactory forward elevation after reverse total shoulder arthroplasty in rotator cuff-deficient conditions and may be one factor in determining the ability to achieve satisfactory outcomes in the rotator cuff-deficient patient.

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Surface Electromyography Reveals Middle Deltoid as The Functionally Dominant Shoulder Muscle After Reverse Total Shoulder Arthroplasty

10.21203/rs.3.rs-519913/v1 ◽

2021 ◽

Author(s):

Emily Lau ◽

Alexander Pietroski ◽

Sreten Franovic ◽

Yang Zhou ◽

Noah Kuhlmann ◽

...

Keyword(s):

Rotator Cuff ◽

Shoulder Arthroplasty ◽

Muscle Activation ◽

Total Shoulder Arthroplasty ◽

Deltoid Muscle ◽

Reverse Total Shoulder Arthroplasty ◽

Shoulder Abduction ◽

Shoulder Muscle ◽

Significant Difference ◽

Reverse Total Shoulder

Abstract Background: Reverse total shoulder arthroplasty (RSA) increases deltoid muscle fiber recruitment and tension to compensate for deficient rotator cuff activity; however, it is unclear whether the anterior or middle deltoid becomes dominant and how the muscle activation profile changes postoperatively. Using minimally invasive electromyography, this study evaluated the activity of the deltoid and surrounding muscles during shoulder motion to assess muscle activation changes post-RSA. Methods: In this observational study, we assessed change in preoperative to postoperative shoulder muscle activation in 10 patients over 6 months. Muscle activation was measured using 8 surface electrodes. Activation of the anterior, middle and posterior deltoid and surrounding muscles were recorded during shoulder abduction, flexion, external and internal rotation were quantified. One-way analysis of variance was used to identify significant differences in activation and time or speed. Least significant difference post hoc test was used to determine specific differences in muscle activation at subsequent time points. Results: RSA shoulders at 6 months postoperative showed a significant increase in activity of the middle deltoid predominantly. Middle deltoid activation increased during abduction (P < 0.001), flexion (P = 0.008), external (P < 0.001) and internal (P < 0.001) rotation. Conclusions: Our study demonstrates the middle deltoid predominates in rotator cuff function in RSA as defined by quantitative activation, significant involvement in all shoulder motions, and increased activation at subsequent times. These findings may help guide future RSA designs to optimize deltoid wrapping allowing for maximal strength and efficiency.

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A “Floating Glenoid” after a Reverse Total Shoulder Arthroplasty: A Case Report with Literature Review

American Journal of Surgical Case Reports ◽

10.31487/j.ajscr.2021.01.02 ◽

2021 ◽

pp. 1-7

Author(s):

Simon N Bell ◽

Maxim U.S.I. Christmas ◽

Jennifer A. Coghlan

Keyword(s):

Rotator Cuff ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Deltoid Muscle ◽

Reverse Total Shoulder Arthroplasty ◽

Rotator Cuff Tears ◽

Surgical Removal ◽

Joint Movement ◽

Complex Proximal Humeral Fractures ◽

Reverse Total Shoulder

A shoulder replacement for cuff tear arthropathy was the original indication of the reverse total shoulder arthroplasty (rTSA). However, over time, this particular concept of shoulder arthroplasty has found new indications for other pathologies such as complex proximal humeral fractures and irreparable rotator cuff tears with rotator cuff arthropathy. Retensioning of the deltoid muscle is a vital step during this procedure in order to restore active elevation however, this can be potentially problematic since it results in anatomical changes and often times increases the stress forces across the acromion. We experienced a rare case of an 84-year-old female presenting with an extensive fracture resulting in a “floating glenoid” after reverse total shoulder arthroplasty via a deltopectoral approach. In our case, the patient presented with gradual onset pain in the posterior shoulder with point tenderness over the acromion, which worsened during active joint movement. The patient was definitively managed with surgical removal of the glenoid implants and conversion to a hemiarthroplasty. While there are existing strategies for preventing fractures of this nature, further research is still necessary to establish best management guidelines of these fracture complications associated with rTSA in order to achieve optimal outcomes.

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