title: Reverse shoulder arthroplasty combined with a modified latissimus dorsi and teres major tendon transfer for shoulder pseudoparalysis associated with dropping arm.
abstract: Although a reverse shoulder arthroplasty (RSA) can restore active elevation in the cuff deficient shoulder, it cannot restore active external rotation when both the infraspinatus and teres minor muscles are absent or atrophied. We hypothesized that a latissimus dorsi and teres major (LD/TM) transfer with a concomitant RSA would restore shoulder function and activities of daily living (ADLs). We prospectively followed 11 consecutive patients (mean age, 70 years) with a combined loss of active elevation and external rotation (shoulder pseudoparalysis and dropping arm) who underwent this procedure. All had severe cuff tear arthropathy (Hamada Stage 3, 4, or 5) and severe atrophy or fatty infiltration of infraspinatus and teres minor on preoperative MRI or CT-scan. The combined procedure was performed through a single deltopectoral approach in the same session. Postoperatively, mean active elevation increased from 70 degrees to 148 degrees (+78 degrees ) and external rotation from -18 degrees to 18 degrees (+36 degrees ). The Constant score, subjective assessment and ADLs improved. The combination of a RSA and LD/TM transfer restored both active elevation and external rotation in this selected subgroup of patients with a cuff deficient shoulder and absent or atrophied infraspinatus and teres minor.
authors.affiliation: Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, University of Nice-Sophia Antipolis, 151 Route de St Antoine de Ginestière, Nice, France. boileau.p@chu-nice.fr
authors.forename: Pascal
authors.initials: P
authors.lastname: Boileau
authors.forename: Christopher
authors.initials: C
authors.lastname: Chuinard
authors.forename: Yannick
authors.initials: Y
authors.lastname: Roussanne
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Bicknell
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rochet
authors.forename: Christophe
authors.initials: C
authors.lastname: Trojani
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001132:Arm / Q000503:physiopathology*; D001178:Arthroplasty / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D017006:Rotator Cuff / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012785:Shoulder Joint / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013709:Tendon Transfer / Q000009:adverse effects; D016896:Treatment Outcome