Loss of subscapularis function after total shoulder replacement: A seldom recognized problem☆

Abstract 

Little attention has focused on subscapularis integrity after total shoulder replacement (TSR). We have noted that several patients have loss of internal rotation and subscapularis function on follow-up, leading to our review of success in restoring subscapularis function after TSR. A retrospective review was done of the records of 41 patients after TSR performed between 1995 and 2000. Mean follow-up was 1.9 years. Terminal internal rotation was evaluated by the lift-off and belly-press examinations. Subscapularis function was assessed by the patients' ability to tuck in a shirt. The subscapularis was repaired anatomically in 9 cases and through bone tunnels in 32 patients. Abnormal results were found for 25 of 37 lift-off examinations (67.5%) and 24 of 36 belly-press examinations (66.6%). Of 25 patients with an abnormal lift-off finding, 92% reported reduced subscapularis function (Fisher exact test, P < .01). Despite meticulous attention to subscapularis repair, suboptimal return of function was found on clinical examination and assessment of activities of daily living. (J Shoulder Elbow Surg 2003;12:29-34)