The influence of deltoid tensioning on functional outcomes following reverse shoulder arthroplasty |
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| Affiliation: | 1. Haseki Training and Research Hospital, U?ur Mumcu Mahallesi, ?stanbul, Turkey;2. Aksaray Universty Education Research Hospital, Yeni Sanayi Mah, Aksaray, Turkey;1. Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA;2. Boston Sports and Shoulder Center, Waltham, MA, USA;3. MedStar Union Memorial Hospital, Baltimore, MD, USA;1. Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA;2. Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France;1. Orthopaedic Associates of Central Texas, Austin, TX, USA;2. Southern Oregon Orthopedics, Medford, OR, USA;3. Banner Health, Phoenix, AZ, USA;4. The Cleveland Shoulder Institute, Beachwood, OH, USA;5. University of Virginia, Charlottesville, VA, USA;1. Division of Orthopedic Surgery, Duke University, Durham, NC, USA;2. School of Medicine, Duke University, Durham, NC, USA;1. Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, Salt Lake City, Utah, USA;2. Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA;1. Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Hospital de Santo António, Porto, Portugal;2. Shoulder Unit, Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Hospital de Santo António, Porto, Portugal;3. Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto (ICBAS-UP), Porto, Portugal;4. Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Hospital de Santo António, Porto, Portugal |
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| Abstract: | BackgroundWe aimed to investigate the relationship between functional outcomes and radiological and clinical measurements (based on deltoid moment arm length measurements) of reverse total shoulder arthroplasty (RTSA) performed in patients for irreparable rotator cuff tears.MethodsThirty-eight patients who underwent RTSA after irreparable rotator cuff tears between 2016 and 2019 were included in the study. Patients with primary osteoarthritis, rheumatoid arthritis, or post-traumatic RTSA were excluded from the study. The patients were evaluated functionally using the range of motion, Quick DASH, and Constant Scores (CS). Deltoid lengthening was measured both clinically by the difference in upper extremity length (dUEL) and radiologically by the acromiohumeral distance (AHD) and deltoid lever length (DLL). AHD was measured with true anteroposterior radiographs and ultrasound guidance.ResultsThe mean age of the patients was 66.39 ± 7.92 (range, 49–83) years. Of 38 patients, 31 (81.57%) were female and 7 (18.43%) were male. The mean follow-up durations were 26.43 ± 17.05 (range, 12–58) months. The mean active anterior elevation (AAE), abduction (AAB), and external rotation (AER) increased from 57.32°, 41.25°, and 22.32° preoperatively to 149°, 110°, and 34° at the last follow-up, respectively. Preoperatively, the mean QuickDASH score was 58.04, and at the last follow-up, it was 38.19. The mean Constant Score rose from 24.75 preoperatively to 60.64 at the last follow-up. The AHD, DLL, and dUEL mean values were 2.346, 1.89, and 1.746 cm, respectively. There was a significant relation between the DLL and the AAE (P < .01).ConclusionOptimizing deltoid tension plays an essential role in regaining function, and this study demonstrates that lengthening the deltoid increases the patient’s ability to elevate anteriorly, likely by recreating the force-length relationship of the deltoid muscle. |
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| Keywords: | Acromiohumeral distance Deltoid muscle Deltoid lengthening Reverse shoulder arthroplasty Rotator cuff Upper extremity length |
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