title: Loss of subscapularis function after total shoulder replacement: A seldom recognized problem.
abstract: Little attention has focused on subscapularis integrity after total shoulder replacement (TSR). We have noted that several patients have loss of internal rotation and subscapularis function on follow-up, leading to our review of success in restoring subscapularis function after TSR. A retrospective review was done of the records of 41 patients after TSR performed between 1995 and 2000. Mean follow-up was 1.9 years. Terminal internal rotation was evaluated by the lift-off and belly-press examinations. Subscapularis function was assessed by the patients' ability to tuck in a shirt. The subscapularis was repaired anatomically in 9 cases and through bone tunnels in 32 patients. Abnormal results were found for 25 of 37 lift-off examinations (67.5%) and 24 of 36 belly-press examinations (66.6%). Of 25 patients with an abnormal lift-off finding, 92% reported reduced subscapularis function (Fisher exact test, P <.01). Despite meticulous attention to subscapularis repair, suboptimal return of function was found on clinical examination and assessment of activities of daily living.
authors.affiliation: Leni and Peter May Department of Orthopaedics, Mount Sinai Hospital, New York, NY, USA.
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Miller
authors.forename: Yassamin
authors.initials: Y
authors.lastname: Hazrati
authors.forename: Steven
authors.initials: S
authors.lastname: Klepps
authors.forename: Alexis
authors.initials: A
authors.lastname: Chiang
authors.forename: Evan L
authors.initials: EL
authors.lastname: Flatow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology; D011183:Postoperative Complications; D012189:Retrospective Studies; D012399:Rotation