Surgical Approach and Dealing With the Subscapularis in Primary Shoulder Arthroplasty

The optimal management of the subscapularis tendon during total shoulder arthroplasty remains controversial. Subscapularis mobilization is required to gain access to the glenohumeral joint during the deltopectoral approach. Failure of the subscapularis to heal, or postoperative rupture, has been associated with poor clinical outcomes. Current evidence supporting subscapularis tenotomy, lesser tuberosity osteotomy, and subscapularis peel are summarized, as surgical techniques. Regardless of technique used, an anatomic and substantial repair with heavy nonabsorbable stitches and plate augmentation is necessary to withstand gentle postoperative rehabilitation. Lack of consensus may be due to difficulty of reliable clinical assessment of subscapularis function after shoulder arthroplasty and lack of agreement between clinical studies comparing techniques.
Source: Techniques in Shoulder and Elbow Surgery - Category: Orthopaedics Tags: Invited Techniques Source Type: research