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Subscapularisdysfunktionen nach ventralen Zugängen zum Schultergelenk

Subscapularis dysfunction following anterior surgical approaches to the shoulder

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Abstract

Anterior approaches to the shoulder including different types of subscapularis tendon takedown or incision techniques bear the risk of iatrogenic damage to the subscapularis musculotendinous unit. Irreversible changes of the muscle in particular fatty infiltration with or without failure of the tendon repair may result in permanent loss of subscapularis function. The true incidence of these structural changes is currently unknown. The degree and clinical impact of subscapularis dysfunction varies depending on the damage to the musculotendinous unit. The subscapularis split approach seems to be the most benign approach for open instability repairs with regard to the musculotendinous integrity. The lesser tuberosity osteotomy appears to be a promising approach for total shoulder replacement to avoid tendinous failures postoperatively. In any case the detachment and mobilization of the subscapularis musculotendinous unit should be carried out with respect to the neural innervation of the subscapularis muscle. Strong and if possible anatomic tendon repair techniques should be used and the repaired tendon must be protected postoperatively.

Zusammenfassung

Anteriore Zugangswege zum Schultergelenk mit Ablösung oder Inzision der Subscapularissehne bergen das Risiko einer iatrogenen Schädigung der muskulotendinösen Einheit des Subscapularis. Irreversible Veränderungen des Muskels wie die fettige Infiltration mit oder ohne Versagen der Sehnenrekonstruktion können zu einem permanenten Verlust der Subscapularisfunktion führen. Die genaue Inzidenz ist gegenwärtig nicht geklärt. Die klinischen Auswirkungen scheinen vom Ausmaß der Schädigung der muskulotendinösen Einheit abhängig zu sein. Der Subscapularis-Split stellt gegenwärtig das Verfahren mit der geringsten Zugangsmorbidität für offene Stabilisierungstechniken dar. Die Tuberkulum minus-Osteotomie zur Endoprothesenimplantation repräsentiert einen vielversprechenden Zugang, um tendinöse Insuffizienzen zu vermeiden. In jedem Fall sollte die Ablösung und Mobilisation des Subscapularis unter Schonung der nervalen Innervation des Muskels durchgeführt werden. Anatomische und primärstabile Refixationstechniken sowie ein angepasstes Nachbehandlungsschema tragen dazu bei, die Zugangsmorbidität so gering wie möglich zu halten.

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References

  1. Ahmad CS,Wing D, Gardner TR, Levine WN, Bigliani LU (2006) Biomechanical evaluation of subscapularis repair used during shoulder arthroplasty. J Shoulder Elbow Surg (Epub ahead of print)

  2. Armstrong A, Lashgari C, Teefey S, Menendez J, Yamaguchi K, Galatz LM (2006) Ultrasound evaluation and clinical correlation of subscapularis repair after total shoulder arthroplasty. J Shoulder Elbow Surg 15:541-548

    Article  PubMed  Google Scholar 

  3. Boileau P,Walch G (1998) The surgical anatomy and osteotomy technique for the humeral head. In: Walch G, Boileau P (eds) Shoulder arthroplasty. Berlin: Springer, pp 105-126

  4. Bottoni CR, Smith EL, Berkowitz MJ, Towle RB,Moore JH (2006) Arthroscopic versus open shoulder stabilization for recurrent anterior instability: a prospective randomized clinical trial. Am J Sports Med 34:1730-1737

    Article  PubMed  Google Scholar 

  5. Burkhart SS, Tehrany AM (2002) Arthroscopic subscapularis tendon repair: technique and preliminary results. Arthroscopy 17:454-463

    Article  Google Scholar 

  6. Checchia SL, Doneaux P, Martins MG, Meireles FS (1996) Subscapularis muscle innervation: the effect of arm position. J Shoulder Elbow Surg 5:214-218

    Article  PubMed  CAS  Google Scholar 

  7. Cleeman E,Brunelli M, Gothelf T, Hayes P, Flatow EL (2003) Release of subscapularis contracture: an anatomic and clinical study. J Shoulder and Elbow Surg 12:231-236

    Article  Google Scholar 

  8. DePalma AF, Cooke AJ, Prabhakar M (1967) The role of the subscapularis in recurrent anterior dislocations of the shoulder. Clin Orthop 54:35-49

    PubMed  CAS  Google Scholar 

  9. Edwards TB, Boulahia A, Kempf JF, Boileau P, Nemoz C, Walch G (2002) The influence of rotator cuff disease on the results of shoulder arthroplasty for primary osteoarthritis: results of a multicenter study. J Bone Joint Surg Am 84A:2240-2248

    Google Scholar 

  10. Gamulin A, Pizzolato G, Stern R, Hoffmeyer P (2002) Anterior shoulder instability: histomorphometric study of the subscapularis and deltoid muscles. Clin Orthop 398:121-126

    Article  PubMed  Google Scholar 

  11. Gerber C, Hersche O, Farron A (1996) Isolated rupture of the subscapularis tendon. Results of operative repair. J Bone Joint Surg Am 78A:1015-1023

    Google Scholar 

  12. Gerber C, Krushell RJ (1991) Isolated tears of the subscapularis muscle.Clinical features in sixteen cases. J Bone Joint Surg Br 73B:389-394

    Google Scholar 

  13. Gerber G, Schneeberger AG, Beck M, Schlegel U (1994) Mechanical strength of repairs of the rotator cuff. J Bone Joint Surg Br 76B:371-380

    Google Scholar 

  14. Gerber G, Schneeberger AG, Perren SM, Nyffeler RW (1999) Experimental rotator cuff repair. A preliminary study. J Bone Joint Surg Am 81A:1281-1290

    Google Scholar 

  15. Gerber C, Yian EH, Pfirrmann CA, Zumstein MA, Werner CM (2005) Subscapularis muscle function and structure after total shoulder replacement with lesser tuberosity osteotomy and repair. J Bone Joint Surg Am 87A:1739-1745

    Article  Google Scholar 

  16. Gill TJ, Micheli LJ, Gebhard F, Binder C (1997) Bankart repair for anterior instability of the shoulder. Long term outcome. J Bone Joint Surg Am 79A:850-857

    Google Scholar 

  17. Goutallier D, Postel JM, Bernageau J, Lavan L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures: Pre- and postoperative evaluation by CT scan. Clin Orthop 304:78-83

    PubMed  Google Scholar 

  18. Greiner S, Gerber Popp A (2005) The subscapularis nerves are anatomical constraints to circumferential release of the subscapularis muscle. Paper presented at the 18th Congress of the European Society for Surgery of the Shoulder and Elbow, Rom, Italy

  19. Greis PE, Dean M, Hawkins RJ (1996) Subscapularis tendon disruption after Bankart reconstruction for anterior instability. J Shoulder Elbow Surg 5:219-222

    Article  PubMed  CAS  Google Scholar 

  20. Habermeyer P, Magosch P, Lichtenberg S (2006) Recentering the Humeral Head for Glenoid Deficiency in Total Shoulder Arthroplasty. Clin Orthop Relat Res (Epub ahead of print)

  21. Habermeyer P, Engel G (2002) Endoprothetik. In: Habermeyer P (ed) Schulterchirurgie. Munich: Urban & Fischer, pp 497-553

  22. Harryman II DT (1992) Common surgical approaches to the shoulder. Instr Course Lect 41:3-11

    PubMed  Google Scholar 

  23. Hertel R, Ballmer FT, Lambert SM, Gerber C (1996) Lag signs in the diagnosis of rotator cuff rupture. J Shoulder Elbow Surg 5:307-313

    Article  PubMed  CAS  Google Scholar 

  24. Hinton MA, Parker AW, Drez D, Altcheck D (1994) An anatomic study of the subscapularis tendon and myotendinous junction. J Shoulder Elbow Surg 3:224-229

    Google Scholar 

  25. Hovelius LK, Sandstrom BC, Rosmark DL, Saebo M, Sundgren KH, Malmqvist BG (2001) Long-term results with the Bankart- and Bristow-Latarjet procedures: recurrent shoulder instability and arthropathy. J Shoulder Elbow Surg 10:445-452

    Article  PubMed  CAS  Google Scholar 

  26. Jobe FW, Giangarra CE, Kvitne RS, Glousman RE (1991) Anterior capsulolabral reconstruction of the shoulder in overhead sports. Am J Sports Med 19:428-434

    Article  PubMed  CAS  Google Scholar 

  27. Jolles BM, Pelet S, Farron A (2004) Traumatic recurrent anterior dislocation of the shoulder: two- to four-year follow-up of an anatomic open procedure. J Shoulder Elbow Surg 13:30-34

    Article  PubMed  Google Scholar 

  28. Kadaba MP, Cole A, Wootten ME, Mc- Cann PD, Reid M, Mulford G, April EW, Bigliani LU (1992) Intramuscular wire electromyography of the subscapularis. J Orthop Res 10:394-397

    Article  PubMed  CAS  Google Scholar 

  29. Kim SH, Oh I, Park J-S, Shin S-K, Jeong WK (2005) Intra-articular repair of an isolated partial articular-surface tear of the subscapularis tendon. Am J Sports Med 33:1825-1830

    Article  PubMed  Google Scholar 

  30. Kronberg M, Nemeth G, Brostrom LA (1990) Muscle activity and coordination in the normal shoulder. Clin Orthop 257:76-85

    PubMed  Google Scholar 

  31. Kuechle DK, Newman SR, Itoi E, Niebur GL, Morrey BF, An KN (1997) The relevance of the moment arm of shoulder muscles with respect to axial rotation of the glenohumeral joint in four positions. Clin Biomech 12:32-38

    Article  Google Scholar 

  32. Lee S-B, Kim K-J, O'Driscoll SW, Morrey BF, An K-N (2000) Dynamic glenohumeral stability provided by the rotator cuff muscles in the mid-range and endrange of motion. J Bone Joint Surg Am 82A:849-857

    Google Scholar 

  33. Liu J, Hughes RE, Smutz WP, Niebur G, Nan-An K (1997) Roles of deltoid and rotator cuff muscles in shoulder elevation. Clin Biomech 12:32-38

    Article  CAS  Google Scholar 

  34. Matsen III FA, Lippitt SB, Sidles JA, Harryman II DT (1994) Practical evaluation of management of the shoulder. Philadelphia: WB Saunders Company, pp 1-242

  35. Maynou C, Cassagnaud X, Mestdagh H (2005) Function of subscapularis after surgical treatment for recurrent instability of the shoulder using a boneblock procedure. J Bone Joint Surg Br 87B:1096-1101

    Google Scholar 

  36. McCann PD, Cordasco FA, Ticker JB, Kadaba MP, Wootten ME, April EW, Bigliani LU (1994) An anatomic study of the subscapular nerves: a guide for electromyographic analysis of the subscapularis muscle. J Shoulder Elbow Surg 3:94-99

    Article  Google Scholar 

  37. Miller BS, Joseph TA, Noonan TJ, Horan MP, Hawkins RJ (2005) Rupture of the subscapularis tendon after shoulder arthroplasty: Diagnosis, treatment and outcome. J Shoulder Elbow Surg 14:492-49

    Article  PubMed  Google Scholar 

  38. Miller SL, Hazrati Y, Klepps S, Chiang A, Flatow EL (2003) Loss of subscapularis function after total shoulder replacement: A seldom recognized problem. J Shoulder Elbow Surg 13:29-34

    Article  Google Scholar 

  39. Millet PJ, Clavert P, Warner JJP (2005) Open operative treatment for anterior shoulder instability: when and why? J Bone Joint Surg Am 87A:419-432

    Article  Google Scholar 

  40. Moeckel BH, Altcheck DW, Warren RF, Wickiewicz TL, Dines DM (1993) Instability of the shoulder after arthroplasty. J Bone Joint Surg Am 75A:492-499

    Google Scholar 

  41. Pfirrmann CWA, Zanetti M, Weishaupt D, Gerber C, Hodler J (1999) Subscapularis tendon tears: detection and grading at MR arthrography. Radiology 213:709-714

    PubMed  CAS  Google Scholar 

  42. Picard F, Saragaglia D, Montbarbon E, Tourne Y, Thony F, Charbel A (1998) Anatomo-clinical effect of subscapular muscle vertical section in Latarjet procedure. Revue de chirurgie orthopédique 84:217-223

    CAS  Google Scholar 

  43. Ponce BA, Ahluwalia RS, Mazzocca AD, Gobezie RG, Warner JJ, Millet PJ (2005) Biomechanical and clinical evaluation of a novel lesser tuberosity repair technique in total shoulder arthroplasty. J Bone Joint Surg Am 87A(Suppl 2):1-8

    Article  Google Scholar 

  44. Sachs RA, Williams B, Stone ML, Paxton L, Kuney M (2005) Open Bankart repair. Correlation of results with postoperative subscapularis function. Am J Sports Med 33:1458-1462

    Article  PubMed  Google Scholar 

  45. Scheibel M, Magosch P, Lichtenberg S, Habermeyer P (2004) Open reconstruction of anterior glenoid rim fractures. Knee Surg Sports Traumatol Arthrosc 12:568-573

    Article  PubMed  Google Scholar 

  46. Scheibel M, Magosch P, Pritsch M, Lichtenberg S, Habermeyer P (2005) The belly-off sign – a new clinical diagnostic sign for subscapularis lesions. Arthroscopy 21:1229-1235

    Article  PubMed  Google Scholar 

  47. Scheibel M, Nikulka C, Dick A, Schroeder RJ, Haas NP: Structural integrity and clinical function of the subscapularis musculotendinous unit after arthroscopic or open shoulder stabilization. AJSM (in press)

  48. Scheibel M, Tsynman A, Magosch P, Schroeder RJ, Habermeyer P (2006) Postoperative subscapularis muscle insufficiency after primary and revision open shoulder stabilization. Am J Sports Med 34:1586-1593

    Article  PubMed  Google Scholar 

  49. Sperling JW, Potter HG, Craig EV, Flatow E, Warren RF (2002) Magnetic resonance imaging of painful shoulder arthroplasty. J Shoulder Elbow Surg 11:315-321

    Article  PubMed  Google Scholar 

  50. Stefko JM, Jobe FW, VanderWilde RS, Carden E, Pink M (1997) Electromyographic and nerve block analysis of the subscapularis lift-off test. J Shoulder Elbow Surg 6:347-355

    Article  PubMed  CAS  Google Scholar 

  51. Symeonides PP (1972) The significance of the subscapularis muscle in the pathogenesis of recurrent anterior dislocation of the glenohumeral joint. J Bone Joint Surg 54:476-483

    CAS  Google Scholar 

  52. Tokish JM, Ellis HB, Decker MJ, Torry MR, Hawkins RJ (2003) The belly-press test for physical examination of the subscapularis muscle: electromyographic validation and comparison to the lift-off test. J Shoulder Elbow Surg 12:427-430

    Article  PubMed  Google Scholar 

  53. Torchia ME, Cofield RH, Settergren CR (1997) Total shoulder arthroplasty with the Neer prosthesis: long-term results. J Shoulder Elbow Surg 6:495-505

    Article  PubMed  CAS  Google Scholar 

  54. Turkel SJ, Panio MW, Marshall JL, Girgis FJ (1981) Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint. J Bone Joint Surg Am 63A:1208-1217

    Google Scholar 

  55. Tuoheti Y, Itoi E, Minagawa H, Wakabayashi I, Kobayashi M, Okada K, Shimada Y (2005) Quantitative assessment of thinning of the subscapularis tendon in recurrent anterior dislocation of the shoulder by use of magnetic resonance imaging. J Shoulder Elbow Surg 14:1-4

    Article  Google Scholar 

  56. Yung SW, Lazarus MD, Harryman DT 2nd (1996) Practical guidelines to safe surgery about the subscapularis. J Shoulder Elbow Surg 5:467-470

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Zentrum für Schulter- und Ellenbogenchirurgie, ATOS-Klinik, Heidelberg

    Peter Habermeyer

  2. Centrum für Muskuloskeletale Chirurgie (CMSC), Campus-Virchow, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Markus Scheibel

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Correspondence to Markus Scheibel.

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Scheibel, M., Habermeyer, P. Subscapularisdysfunktionen nach ventralen Zugängen zum Schultergelenk. Obere Extremität 2, 81–89 (2007). https://doi.org/10.1007/s11678-007-0037-2

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