title: Massive irreparable rotator cuff tear and associated deltoid tear. Does the reverse shoulder arthroplasty and deltoid repair be a possible option of treatment?
abstract: OBJECTIVE
  Rupture of the anterior and middle deltoid muscle associated with rotator cuff tear arthropathy (RCA) could result in a definitive loss of shoulder function. The purpose of this study was to evaluate clinical outcomes after a concomitant reverse shoulder arthroplasty (RSA) and deltoid repair under these circumstances.
  
  
  METHODS
  Between 2006 and 2012, 18 consecutive patients with a mean age of 69.7 years, affected by massive irreparable rotator cuff tear and associated dehiscence or rupture of anterior and middle deltoid muscle underwent this operation through a modified anterosuperior approach. Four patients referred a previous shoulder surgery and deltoid tear was iatrogenic. The other 14 cases had an attritional deltoid tears. The average follow-up was 64 months (range 25-121 months).
  
  
  RESULTS
  The mean active anterior elevation passed from a preoperative mean of 53 ± 9.1 (range 45-70) to 132.7 ± 11.6° (85-155°), active external rotation passed from a preoperative mean value of 22.4 ± 3.6° (range 18-26) to an average of 33.7 ± 4.7° (range 30-40°). Mean Constant score increased from 42 ± 6.1 (range 31-51) pre-operatively to 72.3 ± 8.2 (range 57-82) post-operatively. At final review, deltoid contour subjectively was satisfactory to all patients with no palpable defects.
  
  
  CONCLUSIONS
  RSA associated with a repair of deltoid tear could be a viable surgical option in cases of tear involving the anterior and middle deltoid associated with a RCA. Patient with a preoperative chronic axillary nerve neuropathy associated with a deltoid muscle tear should be cautioned about the possibility of lower functional outcomes.
authors: Upper Limb Unit, F Miulli Hospital, Acquaviva delle Fonti, BA, Italy. Electronic address: raffaelegarofalo@gmail.com.
authors: Raffaele
authors: R
authors: Garofalo
authors: The Shoulder Center, Baylor University Medical Center at Dallas, USA. Electronic address: brody.flanagin@baylorhealth.edu.
authors: Brody
authors: B
authors: Flanagin
authors: Shoulder and Elbow Unit, IRCCS, Humanitas Institute, Milan, Italy. Electronic address: alex.castagna@tin.it.
authors: Alessandro
authors: A
authors: Castagna
authors: Department of Life, Health & Environmental Sciences, University of L'Aquila, Italy.
authors: Vittorio
authors: V
authors: Calvisi
authors: The Shoulder Center, Baylor University Medical Center at Dallas, USA. Electronic address: skrishnan@baylorhealth.edu.
authors: Sumant G
authors: SG
authors: Krishnan
mesh_terms: D000368:Aged; D000072228:Arthroplasty, Replacement, Shoulder / Q000379:methods*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D057645:Deltoid Muscle / Q000293:injuries / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000601:surgery; D010147:Pain Measurement; D011859:Radiography / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D020127:Recovery of Function; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D000070636:Rotator Cuff Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D012421:Rupture / Q000601:surgery; D000070599:Shoulder Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome