Scapular Spine Stress Fracture Following Reverse Total Shoulder Arthroplasty: Successful Management with Low-Intensity Pulsed Ultrasound

Esther Wright; Quen Tang; Edward Ibrahim

doi:10.7759/cureus.10978

Scapular Spine Stress Fracture Following Reverse Total Shoulder Arthroplasty: Successful Management with Low-Intensity Pulsed Ultrasound

Cureus. 2020 Oct 16;12(10):e10978. doi: 10.7759/cureus.10978.

Authors

Esther Wright^{1

2}, Quen Tang¹, Edward Ibrahim¹

Affiliations

¹ Trauma and Orthopaedics, West Middlesex University Hospital, London, GBR.
² Surgery, Imperial College London, London, GBR.

Abstract

Scapular spine stress fractures are a rare but well-recognised complication following reverse total shoulder arthroplasty (RTSA). They present a challenge with no consensus on management. Both operative fixation and conservative measures are associated with high rates of mal- or non-union and decreased functional outcomes. We present the case of a 60-year-old female, who presented with a scapular spine fracture one year following RTSA. Treatment consisted of initial immobilisation, physiotherapy and the application of a portable low-intensity pulsed ultrasound (LIPUS) system (EXOGENÒ Ultrasound Bone Healing System, Bioventus, Durham NC, Netherlands). Following a three-month treatment course, there was a significant improvement in patient-reported pain and functional scores (Oxford Shoulder Score from 5/48 to 38/48). Sequential radiographic imaging confirmed fracture union. Clinicians may consider the use of LIPUS therapy as a potential adjunctive treatment modality to promote the union of scapular spine stress fractures following RTSA.

Keywords: glenohumeral osteoarthritis; non-union; reverse shoulder arthroplasty; scapula.

Publication types

Case Reports