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

2021 ◽  
pp. 1-7
Author(s):  
Simon N Bell ◽  
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.

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

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.

scholarly journals Reverse Total Shoulder Arthroplasty for Massive, Irreparable Rotator Cuff Tears Before the Age of 60 Years

2017 ◽  
Vol 99 (20) ◽  
pp. 1721-1729 ◽  
Author(s):  
Lukas Ernstbrunner ◽  
Aline Suter ◽  
Sabrina Catanzaro ◽  
Stefan Rahm ◽  
Christian Gerber
Keyword(s):  
Rotator Cuff ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Rotator Cuff Tears ◽  
Reverse Total Shoulder

scholarly journals Reverse Total Shoulder Arthroplasty in the Massive Rotator Cuff Tear

2014 ◽  
Vol 17 (3) ◽  
pp. 145-150 ◽  
Author(s):  
Jin Young Jeong ◽  
Hong Eun Cha
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tear ◽  
Cuff Tear ◽  
Biceps Tenotomy ◽  
Reverse Total Shoulder

In the patients of retracted massive rotator cuff tears, there are much of difficulty to functional recovery and pain relief. Nevertheless the development of treatment, there are still debates of the best treatments in the massive rotator cuff tears. Recenlty various of treatments are introduced; these are acromioplasty with debridement, biceps tenotomy, great tuberoplasty with biceps tenotomy, partial repair, mini-open rotator cuff repair, arthroscopic rotator cuff repair, soft tissue augmentation, tendon transfer, flap, hemiarthroplasty, and reverse total shoulder arthroplasty. That there is no difference of result for reverse total shoulder arthroplasty between patients who have massive rotator cuff tear without arthritis and patients who have cuff tear arthropathy. Reverse total shoulder arthroplasty is one of reliable and successful treatment options for massive rotator cuff tear. Especially it is more effective for patients who have a pseudoparalysis.

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

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.

scholarly journals Irreparable Rotator Cuff Tears Without Arthritis Treated With Reverse Total Shoulder Arthroplasty

2016 ◽  
Vol 10 (1) ◽  
pp. 296-308 ◽  
Author(s):  
Mandeep S. Virk ◽  
Gregory P. Nicholson ◽  
Anthony A. Romeo
Keyword(s):  
Rotator Cuff ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Treatment Options ◽  
Young Patients ◽  
Reverse Total Shoulder Arthroplasty ◽  
Rotator Cuff Tears ◽  
Patient Comfort ◽  
Dramatic Improvement ◽  
Reverse Total Shoulder

Background: Irreparable rotator cuff (RC) tears without arthritis is a challenging clinical problem in young adults. Reverse total shoulder arthroplasty (RTSA) has been proposed as one of the surgical treatment options for this condition. Methods: In this review, we discuss the current understanding of the role of RTSA for the management of irreparable RC tears without arthritis based on authors personal experience and available scientific literature. Results: Reverse total shoulder arthroplasty (RTSA) is a constrained arthroplasty system that can allow the deltoid and remaining rotator cuff to substitute for the lost function of irreparable RC. Furthermore, the pain relief is consistent with often a dramatic improvement in patient comfort, shoulder function and stability. In patients with pseudoparalysis of the shoulder without advanced arthritis, RTSA effectively restores forward elevation above the shoulder but may not dramatically improve external (ER) or internal rotation (IR). However, due to concerns over implant longevity, caution has to be exercised when using RTSA for symptomatic irreparable RC tears with preserved active forward elevation (AFE) and in patients less than 65 years of age. Conclusion: RTSA is a reasonable surgical option for irreparable rotator cuff repair without arthritis. However, caution should be exercised when offering RTSA to young patients and patient without pseudoparalysis because they can have a higher complication and dissatisfaction rate. In addition, longevity of RTSA and subsequent need for revision surgery remains a significant concern in this population.

Sign in / Sign up

Export Citation Format

Share Document