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Background: Lower trapezius tendon (LTT) transfer has demonstrated promising results for patients with posterosuperior irreparable rotator cuff tears (PSIRCTs). However, there has been no study evaluating return to work (RTW) and return to sports (RTS) after LTT transfer. Purpose/Hypothesis: The purpose of this study was to assess the rates of RTW and RTS and identify associated factors among patients who have undergone LTT transfer for PSIRCTs. It was hypothesized that LTT transfer would result in favorable functional outcomes and high rates of RTW and RTS. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was conducted on patients who underwent LTT transfer for symptomatic PSIRCTs with minimal glenohumeral arthritis. The clinical assessment included patient-reported outcome measures, testing of active range of motion, and a radiological evaluation of arthritis. Patients were surveyed on occupation, sports activity, RTW or RTS status, time to return, and degree of resumption of previous work and sports levels. Exclusion criteria included a follow-up period of <1 year, revision surgery, postoperative infections, loss to follow-up, and unavailability of data. Results: A total of 110 patients (mean age, 63.0 ± 6.9 years; mean follow-up, 35.3 ± 15.7 months) were included. Clinical scores and active range of motion significantly improved at the final follow-up, with no significant differences between the different work levels. For RTW, 93.6% (n = 103) returned to work (63.1% completely, 36.9% partially), with a mean time to return of 5.2 ± 1.7 months; 6.4% (n = 7) did not return. Patients with lighter work levels had higher return rates and quicker times to return than those with heavier work levels. For RTS, 90.7% (n = 86) returned to sports (70.5% completely, 29.5% partially), with a mean time to return of 5.7 ± 1.3 months. For patients who participated in shoulder sports, 89.9% returned, and 10.1% failed to return. Multivariable logistic regression showed significant associations of higher RTW rates with lighter work levels (odds ratio [OR], 2.72; P =.005) and lower retear rates (OR, 5.41; P =.021). A lower retear rate was also significantly associated with a higher RTS rate (OR, 7.66; P =.010). Conclusion: LTT transfer for PSIRCTs yielded favorable functional outcomes with high rates of RTW and RTS. Patient-related factors, notably work level and retears, influenced successful RTW and RTS. [ABSTRACT FROM AUTHOR]

Background: In young patients with irreparable subscapularis deficiency (SSC-D) and absence of severe osteoarthritis, anterior latissimus dorsi transfer (aLDT) has been proposed as a treatment option to restore the anteroposterior muscular force couple to regain sufficient shoulder function. However, evidence regarding the biomechanical effect of an aLDT on glenohumeral kinematics remains sparse. Purpose/Hypothesis: The purpose of this study was to investigate the effects of an aLDT on range of glenohumeral abduction motion, superior migration of the humeral head (SM), and cumulative deltoid force (cDF) in a simulated SSC-D model using a dynamic shoulder model. It was hypothesized that an aLDT would restore native shoulder kinematics by reestablishing the insufficient anteroposterior force couple. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric shoulders were tested using a validated shoulder simulator. Glenohumeral abduction angle (gAA), SM, and cDF were compared across 3 conditions: (1) native, (2) SSC-D, and (3) aLDT. gAA and SM were measured using 3-dimensional motion tracking, while cDF was recorded in real time during dynamic abduction motion by load cells connected to actuators. Results: The SSC-D significantly decreased gAA (Δ–9.8°; 95% CI, –14.1° to −5.5°; P <.001) and showed a significant increase in SM (Δ2.0 mm; 95% CI, 0.9 to 3.1 mm; P =.003), while cDF was similar (Δ7.8 N; 95% CI, –9.2 to 24.7 N; P =.586) when compared with the native state. Performing an aLDT resulted in a significantly increased gAA (Δ3.8°; 95% CI, 1.8° to 5.7°; P <.001), while cDF (Δ–36.1 N; 95% CI, –48.7 to −23.7 N; P <.001) was significantly reduced compared with the SSC-D. For the aLDT, no anterior subluxation was observed. However, the aLDT was not able to restore native gAA (Δ–6.1°; 95% CI, –8.9° to −3.2°; P <.001). Conclusion: In this cadaveric study, performing an aLDT for an irreparable subscapularis insufficiency restored the anteroposterior force couple and prevented superior and anterior humeral head migration, thus improving glenohumeral kinematics. Furthermore, compensatory deltoid forces were reduced by performing an aLDT. Clinical Relevance: Given the favorable effect of the aLDT on shoulder kinematics in this dynamic shoulder model, performing an aLDT may be considered as a treatment option in patients with irreparable SSC-D. [ABSTRACT FROM AUTHOR]

Background: Glenohumeral arthrodesis is associated with a high rate of complications. Although patients experience reasonable pain relief and shoulder stability, they experience marked limitations in their upper-extremity function. The purpose of this study was to examine the clinical outcomes of glenohumeral arthrodesis.Methods: Twenty-nine patients with 29 affected shoulders underwent primary glenohumeral arthrodesis between 1992 and 2009. Surgical indications included rotator cuff arthropathy and pseudoparalysis (n = 7), neurologic injuries (n = 12), chronic infection (n = 3), recurrent dislocations (n = 3), and proximal humeral or shoulder girdle tumors (n = 4). Surgical fixation techniques included plates and screws in 18 patients and screws only in 11 patients.Results: All patients were examined, with a mean follow-up of 12 years (range, 2 to 22 years). Twelve patients (41%) had postoperative complications, including 6 periprosthetic fractures, 7 nonunions, and 3 infections. Eleven patients (38%) required additional surgical procedures after arthrodesis, including revision internal fixation to achieve glenohumeral fusion after nonunions (n = 7), irrigation and debridement with antibiotic treatment for deep infections (n = 2), open reduction and internal fixation to treat fracture (n = 2), and implant removal to treat symptomatic patients (n = 3). Patients experienced reasonable overall pain relief. The mean postoperative scores were 35 points for the Subjective Shoulder Value, 58 points for the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and 54 points for the Short Form-36. Eighty-seven percent of patients reported postoperative limitations. Patients with neurologic injuries had worse functional outcomes, and an arthrodesis position of ≥25° yielded better functional outcomes.Conclusions: Glenohumeral arthrodesis is associated with a high rate of patients with complications (41%). Although patients experience reasonable pain relief and shoulder stability, they experience marked limitations in their upper-extremity function.Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Theoretically, patients with only one functional arm secondary to contralateral amputation or paralysis will subject their only functional upper extremity to increased loads. This could become an issue after reverse shoulder arthroplasty (RSA). However, there are no reported data on the implant survival or function for patients with a nonfunctional contralateral upper extremity.Objective: To report the outcomes of RSA in patients with contralateral upper extremity amputation or paralysis.Design: Retrospective case series.Setting: Tertiary university hospital.Patients: All patients who underwent RSA between January 2004 and December 2013.Methods: Of 1335 RSA procedures performed, 5 patients had a minimum 2-year follow-up and nonfunctional contralateral upper extremity. There were 3 men and 2 women, with a mean (standard deviation) age and length of follow-up of 72.4 (7.5) years and 56.4 (24-132) months. Two of the patients had a contralateral upper extremity amputation, and the other 3 had contralateral upper extremity paralysis as a result of stroke, traumatic brain injury, and traumatic brachial plexus injury at birth.Main Outcomes: Pain, range of motion, functional scores (Simple Shoulder Test, American Shoulder and Elbow Society and Quick-Disability of the Arm, Shoulder and Hand), satisfaction, complications/reoperations, and radiographic loosening.Results: RSA resulted in substantial improvement in pain (P = .008), forward flexion (P = .02), and external range of motion (P = .01). The mean (standard deviation) Simple Shoulder Test, American Shoulder and Elbow Society, and Quick-Disability of the Arm, Shoulder, and Hand scores were 9.8 (1.3), 82 (13), and 17.8 (13.4), respectively. The results were excellent in 3, satisfactory in 1, and unsatisfactory in 1 patient (due only to external rotation limited to 10°). Subjectively, all 5 patients felt greatly improved and stated they would undergo RSA again. There were no complications or reoperations. There were no shoulders with component loosening.Conclusions: RSA seems to be a safe, effective, and successful surgical procedure for patients with a nonfunctional contralateral upper extremity. Studies with larger sample sizes and longer follow-up will hopefully validate the present findings.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Background: Revision of a shoulder arthroplasty to a reverse shoulder arthroplasty in the presence of glenoid bone loss is especially challenging. The purpose of the present study was to determine the complications and results of glenoid bone-grafting in revision to a reverse shoulder arthroplasty.Methods: Between 2005 and 2010, 143 consecutive reverse shoulder arthroplasties performed as revision procedures were performed at our institution. Glenoid bone-grafting was performed in forty-one shoulders (29%), with 98% (forty) that had follow-up of more than two years (mean, 3.1 years). The 102 patients who did not undergo grafting served as a control group.Results: Seven patients (18%) required another revision surgery because of glenoid loosening (four patients), instability (two patients), or infection (one patient). The two and five-year implant survival rate free of revision for shoulders that had glenoid bone-grafting was 88% and 76%, respectively, which was lower than that for patients who had not required glenoid bone-grafting. The survival rate free of radiographic glenoid loosening at two and five years for the shoulders that had bone-grafting was 92% and 89%, respectively, which was worse than that for those that had not had glenoid bone-grafting. Patients had significant pain relief and improvement in their shoulder range of motion, and they had an increased level of satisfaction compared with the preoperative status. Increased rates of glenoid loosening were seen in patients who had an increased body mass index, an implant with a lateral center of rotation, a previous total shoulder replacement (versus hemiarthroplasty), and in those who were smokers.Conclusions: Although there were relatively high rates of glenoid loosening and reoperation at mid-term follow-up, glenoid reconstruction with bone graft in the revision setting was able to relieve pain and restore shoulder function and stability. [ABSTRACT FROM AUTHOR]

Background: Our purpose was to determine and compare the external rotation moment arm (ERMA) of the latissimus dorsi (LD), teres major (TM), and lower trapezius (LT) when transferred to selected locations on the proximal humerus. We hypothesize that the LT transfer has a higher ERMA compared with LD or TM. Materials and methods: Six fresh frozen cadaveric hemithoraces were used in a novel experimental design. The tendon and joint displacement method was used to calculate ERMA for 6 transfer pairs: LD to superolateral humeral head (SHH), LD to proximal-lateral humeral diaphysis (LHD), TM to SHH, TM to LHD, LT to infraspinatus insertion (ISI), and LT to teres minor insertion (TMI). Results: Tendon transfer pair had a significant effect on ERMA (P < .001), with a significant interaction effect between tendon transfer and position of the humerus (P < .0001). With the humerus at 0° abduction, the ERMAs of the LT-ISI (28.1 mm) or LT-TMI (22.3 mm) transfers were significantly higher than the ERMAs of LD-SHH (10.6 mm; P = .0001, P = .04) or LD-LHD (6.5 mm; P < .0001, P < .001). Also, ERMAs of LT-ISI and LT-TMI transfers were significantly higher than ERMA of TM-LHD (10.4 mm; P = .0001, P = .03). Conclusions: Shoulder external rotation tendon transfers differ in effectiveness and may be affected by arm position. LT potentially results in superior restoration of shoulder external rotation with the arm at the side compared with LD and should be considered as a potential tendon transfer to restore external rotation in selected patients. [ABSTRACT FROM AUTHOR]

Purpose: We evaluated the feasibility of contralateral trapezius transfer to restore shoulder external rotation. Materials and methods: The length of the lower trapezius and distance necessary for contralateral trapezius transfer were measured in 20 volunteers and directly in 12 cadavers. The average distances between the medial spine of the scapula and T12 (length of lower trapezius) and the spine to the greater tuberosity (distance for transfer) were measured with the scapula neutral, maximally protracted, and maximally retracted. In cadavers, the origin of the lower trapezius was detached, transferred to the contralateral greater tuberosity, and retracted to determine its effectiveness in external rotation and tension on the vascular pedicle. Results: In volunteers, the average difference between the length of the lower trapezius and the transfer distance was 19 mm in neutral. When the scapula was protracted and retracted, the difference was 79 and −49 mm. In the cadavers, the average transfer distance (in mm) was 290 ± 12, 365 ± 15, and 209 ± 25 in the neutral, protracted, and retracted positions, respectively. The average length of the lower trapezius (in mm) was 270 ± 10, 285 ± 12, and 258 ± 10 in the neutral, protracted, and retracted positions. The transfer was universally feasible when the scapula was partially retracted. Prolongation of the lower trapezius with lumbar fascia made the transfer possible in all scapular positions. Pulling on the transferred muscle resulted in contralateral shoulder external rotation without tension or impingement on the neurovascular pedicle. Conclusion: Contralateral trapezius transfer to the infraspinatus insertion appears feasible and potentially effective in restoration of shoulder external rotation. [ABSTRACT FROM AUTHOR]