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Surgical Approach and Dealing With the Subscapularis in Primary Shoulder Arthroplasty

Rollins, Meaghan D. MBBCh, BAO, FRCSC; Lapner, Peter L.C. MD, FRCSC

Techniques in Shoulder & Elbow Surgery: March 2016 - Volume 17 - Issue 1 - p 7–10
doi: 10.1097/BTE.0000000000000076
Invited Techniques
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The optimal management of the subscapularis tendon during total shoulder arthroplasty remains controversial. Subscapularis mobilization is required to gain access to the glenohumeral joint during the deltopectoral approach. Failure of the subscapularis to heal, or postoperative rupture, has been associated with poor clinical outcomes. Current evidence supporting subscapularis tenotomy, lesser tuberosity osteotomy, and subscapularis peel are summarized, as surgical techniques. Regardless of technique used, an anatomic and substantial repair with heavy nonabsorbable stitches and plate augmentation is necessary to withstand gentle postoperative rehabilitation. Lack of consensus may be due to difficulty of reliable clinical assessment of subscapularis function after shoulder arthroplasty and lack of agreement between clinical studies comparing techniques.

*Department of Surgery, McMaster University, Hamilton

Division of Orthopedics, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada

The authors declare no conflict of interest.

Reprints: Peter L.C. Lapner, MD, FRCSC, The Ottawa Hospital, General Campus, 501 Smyth Rd., W1648, Box 502, Ottawa, ON, Canada K1H 8L6 (e-mail: plapner@toh.on.ca).

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