Authors
H. TytgatPeter B. MacDonaldFilip Verhaegen
Topics
Shoulder Injury and TreatmentShoulder and Clavicle InjuriesNerve Injury and RehabilitationCurrent Concepts ReviewHannes Tytgat a,*, Peter Macdonald b,c, Filip Verhaegen d a AZ St. Dimpna Geel, J.-B. Stessenstraat 2, 2440 Geel, Belgium b Pan Am Clinic, Winnipeg, MB, R3M 3E4, Canada c Department of Surgery, Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, MB, R3A 1R9, Canada d UZ Leuven, Department of Orthopedics, Herestraat 49, 3000 Leuven, BelgiumA R T I C L E I N F OKeywords: Irreparable subscapularis tears Musculotendinous transfer Latissimus dorsi transfer Pectoralis major transfer Pectoralis minor transfer Anterior capsule reconstructionA B S T R A C TPrimary repair of acute subscapularis (SSC) tears provides excellent results, but tendon retraction, muscle atrophy, fatty infiltration, and humeral head migration may render a more chronic tear irreparable. These irreparable SSC tears present a diagnostic and treatment challenge for orthopaedic surgeons. Careful physical examination and imaging evaluation can help to distinguish those with reparable versus irreparable tears, but they are still not very reliable due to the methodological limitations of current evidence. Therefore, future research using 3D and quantitative measurement techniques is necessary to better predict the irreparability of the SSC. When conservative treatment of an irreparable SSC tear fails, reversed shoulder arthroplasty has been estab lished as the preferred treatment option for older, low-demand patients with arthropathy, providing reliable improvements in pain and function. In younger patients without significant arthropathy, musculotendinous transfers are the treatment of choice. The pectoralis major transfer is historically the most frequently performed procedure and provides improved range of motion and pain relief, but fails to adequately restore strength and shoulder function. The latissimus dorsi transfer has gained increased interest over the last few years due to its biomechanical superiority, and early clinical studies suggest improved outcomes as well. More recently, anterior capsular reconstruction has been proposed as an alternative to musculotendinous transfers, but clinical data are completely lacking. Future high-quality randomised controlled trials are necessary to reliably compare the different musculotendinous transfers and anterior capsular reconstruction.Subscapularis tendon tears may become irreparable due to tendon retraction, muscle fatty infiltration and atrophy, and humeral head migration. In young, active patients without arthropathy, muscu lotendinous transfers are the preferred treatment option. The pectoralis major transfer is historically the most frequently per formed procedure, but the latissimus dorsi transfer is gaining increased interest due to its biomechanical superiority. Anterior capsular reconstruction has been recently proposed as an alternative to musculotendinous transfers, but clinical data are lacking. Reversed shoulder arthroplasty is the preferred treatment option for older, low-demand patients with arthropathy.
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PublishedOct 23, 2023
TypeArticle
Citations13
References74