The Hip
Home » Joints » Shoulder » Shoulder Arthroplasty – Mobilization and Repair of Subscapularis

Shoulder Arthroplasty – Mobilization and Repair of Subscapularis

- Discussion:
       - subscapularis anatomy: mobilization (360 deg release):
       - mobility of the subscapularis can be limited by adhesions to conjoined muscles, coracoid, glenoid, and capsule;
       - releases are required order to liberate subscapularis circumferentially about its long axis; 
       - muscle should be fully mobilized off of the anterior glenoid;
       - is detached from its insertion on lesser tuberosity and is incised together with the underlying anterior aspect of capsule (provides a thicker and
                 stronger structure for reattachment);
       - adhesions from the base of the coracoid process are released, and the entire anterior aspect of the capsule is excised;
       - double spike homan retractor is then placed on anterior glenoid and is levered off of it to provide anterior retraction;
       - this homan retractor can be anchored to the Charnley retractor w/ a bone clamp;
       - deep exposure is not complete until the shoulder can be easily externally rotated without having to torque on the humerus;
       - references:
              - Subscapularis Muscle Function and Structure After Total Shoulder Replacement with Lesser Tuberosity Osteotomy and Repair.
              - Clinical, Radiographic, and Ultrasonographic Comparison of Subscapularis Tenotomy and Lesser Tuberosity Osteotomy for Total Shoulder Arthroplasty.
              - Long head of the biceps pathology as a cause of anterior shoulder pain after shoulder arthroplasty.
              - The role of concomitant biceps tenodesis in shoulder arthroplasty for primary osteoarthritis: results of a multicentric study.
              - Biomechanical Comparison of Lesser Tuberosity Osteotomy Versus Subscapularis Tenotomy in Total Shoulder Arthroplasty
              - Subscapularis release in shoulder replacement determines structural muscular changes

........................................................................................................................................................................................................................................................................................................