Management of the subscapularis contracture during shoulder arthroplasty for primary glenohumeral arthritis |
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Authors: | Fama Giuseppe Nava Pasquale Pini Silvia Cossettini Marina Mary Pozzuoli Assunta |
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Institution: | (1) Ortopedia e Traumatologia, Azienda Ospedaliera-University of Padua, Padua, Italy;(2) Clinica Ortopedica e Traumatologica Dipartimento di Medicina e Chirurgia, University of Padua, Padua, Italy |
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Abstract: | Aim To evaluate the safety and effectiveness of a particular subscapularis release in shoulder arthroplasty for primary glenohumeral
arthritis.
Materials and methods Twenty-eight patients (19F, 9M) underwent shoulder arthroplasty for primary glenohumeral arthritis. Preoperative average Constant
Score (CS) was 31.2 points (range 14–52), active anterior elevation (AAE) 92° (30–100°) and active external rotation (AER)
11° (−40 to 20°). During arthroplasty for subscapularis contracture, patients underwent subscapularis release freeing the
superior tubular tendon (STT) with a section of the coracohumeral ligament (CHL) and the superior glenohumeral ligament (SGHL)
and a deep release consisting of a section of the middle glenohumeral ligament (MGHL), very close to the glenoid labrum, and
the inferior glenohumeral ligament (IGHL). An anatomic study was performed on 13 cadavers, verifying the structure of subscapularis
tendon and its relationship with the capsule, the surrounding ligaments and the axillary nerve. Moreover, after having placed
traction sutures on the subscapularis tendon, its lengthening was measured after STT release alone and after STT and deep
release. The complete absence of neurological and vascular lesions was also verified.
Results Average follow-up: 2.9 years. Postoperative mean CS was 70.5 (p〈0.005), with an absolute gain of 39.1. AAE increased from 92° to 142° (p=0.001) while AER increased from 8° to 48° (p=0.002). At the last follow-up, 19 patients (67.8%) were very satisfied, 5 patients (17.8%) were satisfied, 3 patients (10.7%)
partially satisfied and 1 patient (3.5%) unsatisfied. In the anatomic control, the average lengthening of subscapularis tendon
was 0.9 cm after STT release alone and 2.5 cm after STT and deep release. No vascular and neurological lesions were observed.
Conclusions The subscapularis release during shoulder arthroplasty is extremely important to obtain the proper balance between anterior
and posterior soft tissues and to achieve an optimal range of motion and joint stability. An adequate anatomical dissection
could give good tendon mobilisation and lengthening, necessary for a good repair, and lead to a recovery of the range of motion,
particularly for external rotation. |
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Keywords: | Release Subscapularis Shoulder arthroplasty |
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