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Subscapularis handling in anatomical shoulder arthroplasty

Behandlung des M. subscapularis bei der Schulterarthroplastik

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Abstract

Anatomical shoulder arthroplasty is a reliable method used to alleviate pain and improve function in patients with glenohumeral arthritis. Recent research has focused on the handling of the subscapularis during anatomical shoulder arthroplasty. Four different approaches have been described: subscapularis tenotomy, subscapularis tendon peel, lesser tuberosity osteotomy, or a subscapularis preserving technique. In the literature, lesser tuberosity osteotomy shows better biomechanical and clinical results compared with subscapularis tenotomy. Two surgical techniques for lesser tuberosity osteotomy have been described: in line with the subscapularis tendon or perpendicular to the tendon. Both techniques show a high union rate and good clinical results but currently no biomechanical, radiological (muscular fatty degeneration), or randomized controlled clinical testing has been performed to evaluate significant differences. Subscapularis preserving techniques show good clinical results but are technically very demanding.

Zusammenfassung

Die anatomische Schulterarthroplastik ist ein reliables Verfahren zur Schmerzlinderung und Funktionsverbesserung bei Patienten mit glenohumeraler Arthritis. Der Fokus neuerer Untersuchungen lag auf dem Umgang mit dem M. subscapularis bei der Schulterarthroplastik. Es sind 4 verschiedene Ansätze beschrieben worden: Die Subskapularistenotomie, die Subskapularissehnenlösung, die Osteotomie des Tuberculum minus oder eine Subskapulariserhaltungstechnik. In der Literatur zeigt die Osteotomie des Tuberculum minus bessere biomechanische und klinische Ergebnisse als die Subskapularistenotomie oder die Subskapularissehnenlösung. Für die Osteotomie des Tuberculum minus sind 2 Operationstechniken beschrieben worden: parallel zur Subskapularissehne oder senkrecht zur Sehne. Beide Techniken weisen eine hohe Verbindungsrate und gute klinische Ergebnisse auf, jedoch sind bisher keine biomechanischen, radiologischen (muskuläre fettige Degeneration) oder randomisierten, kontrollierten klinischen Untersuchungen zur Prüfung signifikanter Unterschiede durchgeführt worden. Subskapulariserhaltungstechniken weisen gute klinische Ergebnisse auf, sind aber technisch sehr anspruchsvoll.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium

    Alexander Van Tongel M.D., Ph.D. & Lieven De Wilde

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  1. Alexander Van Tongel M.D., Ph.D.
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  2. Lieven De Wilde
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Correspondence to Alexander Van Tongel M.D., Ph.D..

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A. Van Tongel and L. De Wilde state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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Van Tongel, A., De Wilde, L. Subscapularis handling in anatomical shoulder arthroplasty. Obere Extremität 10, 41–46 (2015). https://doi.org/10.1007/s11678-014-0296-7

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