Subscapularis Tendon - Revision history

Alexandre.laedermann: /* Pectoralis major transfer */

2020-01-03T16:58:10Z

Pectoralis major transfer

Alexandre.laedermann: /* Pectoralis major transfer */

2020-01-03T16:52:05Z

Pectoralis major transfer

Alexandre.laedermann: /* Complications */

2020-01-03T16:51:42Z

Complications

Alexandre.laedermann: /* Results */

2020-01-03T16:51:18Z

Results

Alexandre.laedermann: /* Surgical Technique for Middle Glenohumeral Ligament Abrasion Causing Upper Subscapularis Tear (FUSSI, SAM tears) */

2020-01-03T16:50:19Z

Surgical Technique for Middle Glenohumeral Ligament Abrasion Causing Upper Subscapularis Tear (FUSSI, SAM tears)

Alexandre.laedermann: /* Postoperative Management */

2020-01-03T16:48:30Z

Postoperative Management

Alexandre.laedermann: /* Surgical Technique for Middle Glenohumeral Ligament Abrasion Causing Upper Subscapularis Tear (FUSSI, SAM tears) */

2020-01-03T16:47:57Z

Surgical Technique for Middle Glenohumeral Ligament Abrasion Causing Upper Subscapularis Tear (FUSSI, SAM tears)

Alexandre.laedermann: /* Surgical Technique for Middle Glenohumeral Ligament Abrasion Causing Upper Subscapularis Tear (FUSSI, SAM tears) */

2020-01-03T16:44:43Z

Surgical Technique for Middle Glenohumeral Ligament Abrasion Causing Upper Subscapularis Tear (FUSSI, SAM tears)

Alexandre.laedermann: /* Surgical Technique for Middle Glenohumeral Ligament Abrasion Causing Upper Subscapularis Tear (FUSSI, SAM tears) */

2020-01-03T16:44:11Z

Surgical Technique for Middle Glenohumeral Ligament Abrasion Causing Upper Subscapularis Tear (FUSSI, SAM tears)

Alexandre.laedermann: /* Surgical Technique for Middle Glenohumeral Ligament Abrasion Causing Upper Subscapularis Tear (FUSSI, SAM tears) */

2020-01-03T16:42:44Z

Surgical Technique for Middle Glenohumeral Ligament Abrasion Causing Upper Subscapularis Tear (FUSSI, SAM tears)

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 <br />
-== Postoperative Management ==
+==Postoperative Management==
 The inferior subscapularis, depending of the movements or exercises proposed after the surgery, is elongated up to 122%.<ref>Charbonnier C, Lädermann A, Kevelham B, Chague S, Hoffmeyer P, Holzer N. Shoulder strengthening exercises adapted to specific shoulder pathologies can be selected using new simulation techniques: a pilot study. Int J Comput Assist Radiol Surg. 2018 Feb;13(2):321-330.</ref>
 If repaired, this muscle must consequently be protected during rehabilitation. Postoperatively the patient is placed in a sling for four to six weeks, depending of the type of lesion. In the case of type-I to type-II, external rotation is allowed to 30 degrees during this period. If the tear was a type-III or a type-IV, external rotation past neutral and internal rotation hand in the back are forbidden for six weeks.
-== Results ==
+==Results==
 Since the first description in 2002, several authors have reported the results of arthroscopic repair of subscapularis tendon tears.<ref>Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R. Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am 2007;89:1184-93.</ref><ref>Bennett WF. Arthroscopic repair of isolated subscapularis tears: A prospective cohort with 2- to 4-year follow-up. Arthroscopy 2003;19:131-43.</ref><ref>Ide J, Tokiyoshi A, Hirose J, Mizuta H. Arthroscopic repair of traumatic combined rotator cuff tears involving the subscapularis tendon. J Bone Joint Surg Am 2007;89:2378-88.</ref><ref>Kim SH, Oh I, Park JS, Shin SK, Jeong WK. Intra-articular repair of an isolated partial articular-surface tear of the subscapularis tendon. Am J Sports Med 2005;33:1825-30.</ref>
 These studies have all demonstrated good results at short- to intermediate-term follow-up. Lafosse and colleagues reported the functional outcome and integrity of repair of 17 arthroscopically repaired isolated subscapularis tears.8 At an average 29 month follow-up UCLA scores had improved from 16 to 32 and relative Constant scores improved from 58 to 96. Healing was assessed with computed tomography arthrography and showed complete healing in 15 patients and partial re-rupture in two patients. Denard et al. published a long-term follow-up after arthroscopic subscapularis repair.49 Seventy-nine patients with an average age of 60.8 years at the time of surgery were available for follow-up at a mean of 104.7 months. Compared to preoperative values, UCLA mean scores improved from 16.5 to 30.1 and mean ASES scores improved from 40.8 to 88.5 (p < .001). Results were rated as good or excellent in 83.3% of cases, 92.4% of patients returned to normal activities, and 92.4% of patients were satisfied. Improvement in functional outcome following arthroscopic repair of a subscapularis tendon tear is maintained long-term.<ref>Denard PJ, Jiwani AZ, Ladermann A, Burkhart SS. Long-term outcome of a consecutive series of subscapularis tendon tears repaired arthroscopically. Arthroscopy 2012;28:1587-91.</ref>
-== Complications ==
+==Complications==
 The complication rate after shoulder arthroscopy is very low. Theoretically there is risk of damage to neurovascular structures when performing work around the coracoid. These structures are all greater than 2.5 cm from the coracoid tip.50 Therefore, maintaining visualization of the coracoid ensures safety of the procedure.<ref>Lo IK, Burkhart SS, Parten PM. Surgery about the coracoid: neurovascular structures at risk. Arthroscopy 2004;20:591-5.</ref>
-== Subscapularis Dysfunction After Shoulder Arthroplasty ==
+==Subscapularis Dysfunction After Shoulder Arthroplasty==
 Please refer to Glenohumeral Arthritis/Anatomic Shoulder Arthroplasty
-== Irreparable Subscapularis Tear ==
+==Irreparable Subscapularis Tear==
-=== Pectoralis major transfer ===
+===Pectoralis major transfer===
 Currently, the most commonly used transfer for irreparable A, B and C type massive rotator cuff tears is the pectoralis major transfer. The direction of pull of the pectoralis major tendon can help restore internal rotation and the transverse force couple in the setting of subscapularis deficiency without static anterosuperior migration of the humeral head. Pain can be improved, but functional restoration is often disappointing.<ref>Gavriilidis I, Kircher J, Magosch P, Lichtenberg S, Habermeyer P. Pectoralis major transfer for the treatment of irreparable anterosuperior rotator cuff tears. Int orthop 2010;34:689-94.</ref><br />
 ==References==
 <references />

@@ Line 228: / Line 228: @@
 === Pectoralis major transfer ===
-Currently, the most commonly used transfer for irreparable A, B and C type massive rotator cuff tears is the pectoralis major transfer. The direction of pull of the pectoralis major tendon can help restore internal rotation and the transverse force couple in the setting of subscapularis deficiency without static anterosuperior migration of the humeral head. Pain can be improved, but functional restoration is often disappointing.
+Currently, the most commonly used transfer for irreparable A, B and C type massive rotator cuff tears is the pectoralis major transfer. The direction of pull of the pectoralis major tendon can help restore internal rotation and the transverse force couple in the setting of subscapularis deficiency without static anterosuperior migration of the humeral head. Pain can be improved, but functional restoration is often disappointing.<ref>Gavriilidis I, Kircher J, Magosch P, Lichtenberg S, Habermeyer P. Pectoralis major transfer for the treatment of irreparable anterosuperior rotator cuff tears. Int orthop 2010;34:689-94.</ref><br />
 ==References==
 <references />

@@ Line 220: / Line 220: @@
 == Complications ==
-The complication rate after shoulder arthroscopy is very low. Theoretically there is risk of damage to neurovascular structures when performing work around the coracoid. These structures are all greater than 2.5 cm from the coracoid tip.50 Therefore, maintaining visualization of the coracoid ensures safety of the procedure.
+The complication rate after shoulder arthroscopy is very low. Theoretically there is risk of damage to neurovascular structures when performing work around the coracoid. These structures are all greater than 2.5 cm from the coracoid tip.50 Therefore, maintaining visualization of the coracoid ensures safety of the procedure.<ref>Lo IK, Burkhart SS, Parten PM. Surgery about the coracoid: neurovascular structures at risk. Arthroscopy 2004;20:591-5.</ref>
 == Subscapularis Dysfunction After Shoulder Arthroplasty ==

@@ Line 215: / Line 215: @@
 == Results ==
-Since the first description in 2002, several authors have reported the results of arthroscopic repair of subscapularis tendon tears.
+Since the first description in 2002, several authors have reported the results of arthroscopic repair of subscapularis tendon tears.<ref>Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R. Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am 2007;89:1184-93.</ref><ref>Bennett WF. Arthroscopic repair of isolated subscapularis tears: A prospective cohort with 2- to 4-year follow-up. Arthroscopy 2003;19:131-43.</ref><ref>Ide J, Tokiyoshi A, Hirose J, Mizuta H. Arthroscopic repair of traumatic combined rotator cuff tears involving the subscapularis tendon. J Bone Joint Surg Am 2007;89:2378-88.</ref><ref>Kim SH, Oh I, Park JS, Shin SK, Jeong WK. Intra-articular repair of an isolated partial articular-surface tear of the subscapularis tendon. Am J Sports Med 2005;33:1825-30.</ref>
-. Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R. Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am 2007;89:1184-93.
+These studies have all demonstrated good results at short- to intermediate-term follow-up. Lafosse and colleagues reported the functional outcome and integrity of repair of 17 arthroscopically repaired isolated subscapularis tears.8 At an average 29 month follow-up UCLA scores had improved from 16 to 32 and relative Constant scores improved from 58 to 96. Healing was assessed with computed tomography arthrography and showed complete healing in 15 patients and partial re-rupture in two patients. Denard et al. published a long-term follow-up after arthroscopic subscapularis repair.49 Seventy-nine patients with an average age of 60.8 years at the time of surgery were available for follow-up at a mean of 104.7 months. Compared to preoperative values, UCLA mean scores improved from 16.5 to 30.1 and mean ASES scores improved from 40.8 to 88.5 (p < .001). Results were rated as good or excellent in 83.3% of cases, 92.4% of patients returned to normal activities, and 92.4% of patients were satisfied. Improvement in functional outcome following arthroscopic repair of a subscapularis tendon tear is maintained long-term.<ref>Denard PJ, Jiwani AZ, Ladermann A, Burkhart SS. Long-term outcome of a consecutive series of subscapularis tendon tears repaired arthroscopically. Arthroscopy 2012;28:1587-91.</ref>
 == Complications ==

@@ Line 205: / Line 205: @@
 Frequently the middle glenohumeral ligament will have a relatively sharpened edge which can clearly be seen as the pathologic lesion creating the upper subscapularis pathology. After completion of the intraarticular diagnostic arthroscopy, an anterosuperolateral and / or anterior portal are created. Through this anterior portal the edge (and usually the entirety) of the middle glenohumeral ligament is divided with arthroscopic scissors, shaver, electrocautery, or combination of the above. The anterior aspect of the shoulder is then re-examined and rotation of the humerus performed to confirm that the previous lesion is now adequately addressed (Figure).
 [[File:1562442209747-lg.jpg|center|thumb|750x750px|Figure. 15 <br>(A) Posterior portal view of the right shoulder with a 30_ arthroscope. An anterior portal is created and curved arthroscopic scissors (Arthrex) are used to divide the MGHL just over top of the upper subscapularis (SSc) tendon. The humeral head (H) is visible on the lower right. <br>(B) Posterior portal view of the right shoulder with a 30_ arthroscope. An arthroscopic shaver is also used to assure complete excision of the MGHL (*) over the top and front of the subscapularis (SSc). The humeral head (H) is visible in the lower right. (MGHL, middle glenohumeral ligament.) Reproduce from Brady et al., with permission.]]
-Particular care is also taken to thoroughly examine the remainder of the intraarticular structures in the anterior aspect of the shoulder (Figure). Eventually anterior glenoplasty or coracoplasty, in order to allow proper gliding of the superior border of the tendon, is performed.
+Particular care is also taken to thoroughly examine the remainder of the intraarticular structures in the anterior aspect of the shoulder (Figure). Eventually anterior glenoplasty or coracoplasty, in order to allow proper gliding of the superior border of the tendon, is performed.<ref>Cunningham G, Lädermann A. Redefining anterior shoulder impingement: a literature review. Int Orthop. 2018 Feb;42(2):359-366. doi:</ref>
 [[File:1562442488014-lg.jpg|center|thumb|600x600px|Figure. 16 After complete release and excision of the middle glenohumeral ligament, the offending lesion upon the subscapularis is clearly removed and the upper subscapularis contour returns to near normal. Reproduce from Brady et al., with permission.]]
 <br />

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 [[File:1562767538017-lg.mp4|center|thumb|750x750px]]
 On initial inspection of the upper border of the subscapularis an abrasion lesion or a tendon indentation / partial tearing is noted approximately 1-2 cm medial to the articular insertion of the upper subscapularis on the lesser tuberosity bone bed. The lesion is in close approximation to the lateral edge of the middle glenohumeral ligament. Typically, with internal rotation of the humerus the middle glenohumeral ligament is seen “cutting” into the upper boarder of the subscapularis (Figure).
-[[File:1562442208871-lg.jpg|center|thumb|750x750px|Figure. 14 (A) Posterior portal view of the right shoulder with a 30_ arthroscope. The humeral head (H) is on the lower right. The MGHL (labeled) sits approximately 1 cm medial to a significant abrasion lesion of the upper boarder of the subscapularis (*).
+[[File:1562442208871-lg.jpg|center|thumb|750x750px|Figure. 14 <br>(A) Posterior portal view of the right shoulder with a 30_ arthroscope. The humeral head (H) is on the lower right. The MGHL (labeled) sits approximately 1 cm medial to a significant abrasion lesion of the upper boarder of the subscapularis (*).<br>
 (B) Posterior portal view of the right shoulder with a 30_ arthroscope. The glenoid (G) is visible on the left side of the field of view. With internal rotation of the humerus, the MGHL (labeled) can clearly be seen to be the offending lesion cutting into the upper subscapularis causing the pathology in the subscapularis. (MGHL, middle glenohumeral ligament.) Reproduce from Brady et al., with permission.]]