Sonographic assessment of the subscapularis after reverse shoulder arthroplasty: impact of tendon integrity on shoulder function

J Shoulder Elbow Surg. 2018 Jun;27(6):1051-1056. doi: 10.1016/j.jse.2017.12.008. Epub 2018 Feb 12.


Background: The deltopectoral approach for reverse shoulder arthroplasty (RSA) requires subscapularis tenotomy or lesser tuberosity osteotomy. Whether the subscapularis should be repaired at the conclusion of the procedure remains controversial. The present study sonographically assessed the subscapularis after RSA and evaluated the effect of tendon integrity on functional outcome.

Methods: All patients who had undergone RSA in the Gold Coast University Hospital between 2005 and 2016 were included. Sonography was performed by a blinded examiner. Function was assessed using the Disabilities of the Arm, Shoulder and Hand, the Constant-Murley, and Oxford Shoulder scores. Internal rotation ability was recorded on a 6-point scale.

Results: The study included 43 patients (48 shoulders). Median length of follow-up was 19 months (range, 4-132 months). On sonography, the subscapularis was graded intact in 6 shoulders (13%), intact with mild attenuation in 16 (33%), severely attenuated in 15 (31%), and not intact or absent in 11 (23%). Differences in Disabilities of the Arm, Shoulder and Hand, Constant-Murley, or Oxford Shoulder scores between intact and attenuated or absent subscapularis shoulders were not significant. Internal rotation scores were significantly higher in the intact and mildly attenuated tendon group than in the absent tendon group (U = 1.0, P = .001 and U = 28.5, P = .007, respectively).

Conclusions: The present work is the first long-term outcome study of RSA using sonography to assess the subscapularis. Subscapularis integrity did not appear to have a measurable effect on patient outcome as measured by standard scores but was important for internal rotation ability after RSA.

Keywords: Shoulder; arthroplasty; internal rotation; reverse; sonography; subscapularis.

MeSH terms

  • Adult
  • Aged
  • Arthroplasty, Replacement, Shoulder*
  • Female
  • Humans
  • Humerus / surgery
  • Male
  • Middle Aged
  • Osteotomy
  • Range of Motion, Articular
  • Reoperation
  • Rotator Cuff / diagnostic imaging*
  • Rotator Cuff / surgery
  • Shoulder Joint / diagnostic imaging
  • Shoulder Joint / physiopathology*
  • Shoulder Joint / surgery
  • Tendons / surgery
  • Tenotomy
  • Treatment Outcome
  • Ultrasonography