Outcome of reverse shoulder arthroplasty with pedicled pectoralis transfer in patients with deltoid paralysis

J Shoulder Elbow Surg. 2018 Jan;27(1):96-103. doi: 10.1016/j.jse.2017.07.007. Epub 2017 Sep 20.

Abstract

Background: Management of shoulder arthritis associated with deltoid paralysis can be very challenging. The purpose of this study was to report the outcome of reverse shoulder arthroplasty with pedicled pectoralis transfer to reconstruct the anterior deltoid in patients with symptomatic shoulder arthritis and a paralyzed deltoid.

Methods: This study included 31 patients with an average age of 51 years (range, 27-73 years). All patients had chronic deltoid paralysis with significant loss of function due to progressive arthritis associated with rotator cuff deficiency. All patients underwent reverse shoulder arthroplasty with pedicled pectoralis muscle transfer. Additional transfers were performed in patients with no preoperative external rotation: 5 underwent latissimus transfer, and 3 underwent direct lower trapezius transfer to the infraspinatus.

Results: At an average follow-up of 37 months, 29 patients had significant improvements in pain; the shoulder subjective value; the Disabilities of the Arm, Shoulder and Hand score; and shoulder range of motion, mainly flexion of 83° and external rotation of 15°. Two patients sustained postoperative acromial fractures and had persistent pain after surgery with minimal improvement in shoulder flexion and external rotation. One of them had a failed attempt at open reduction-internal fixation of the acromion.

Conclusion: Reverse shoulder arthroplasty with pedicled pectoralis transfer is a promising procedure that may lead to improved pain and function in patients with shoulder arthritis associated with deltoid paralysis.

Keywords: Pectoralis; arthroplasty; axillary nerve; deltoid; paralysis; reverse; shoulder.

MeSH terms

  • Adult
  • Aged
  • Arthritis / complications
  • Arthritis / surgery*
  • Arthroplasty, Replacement, Shoulder*
  • Deltoid Muscle / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Paralysis / etiology
  • Paralysis / surgery*
  • Pectoralis Muscles / transplantation*
  • Range of Motion, Articular / physiology
  • Retrospective Studies
  • Shoulder Joint*
  • Treatment Outcome
  • Young Adult