- Discussion:
- subscapularis anatomy: mobilization (360 deg release):
- mobility of the subscapularis can be limited by adhesions to conjoined muscles, coracoid, glenoid, and capsule;
- releases are required order to liberate subscapularis circumferentially about its long axis;
- muscle should be fully mobilized off of the anterior glenoid;
- is detached from its insertion on lesser tuberosity and is incised together with the underlying anterior aspect of capsule (provides a thicker and
stronger structure for reattachment);
- adhesions from the base of the coracoid process are released, and the entire anterior aspect of the capsule is excised;
- double spike homan retractor is then placed on anterior glenoid and is levered off of it to provide anterior retraction;
- this homan retractor can be anchored to the Charnley retractor w/ a bone clamp;
- deep exposure is not complete until the shoulder can be easily externally rotated without having to torque on the humerus;
- references:
- Subscapularis Muscle Function and Structure After Total Shoulder Replacement with Lesser Tuberosity Osteotomy and Repair.
- Clinical, Radiographic, and Ultrasonographic Comparison of Subscapularis Tenotomy and Lesser Tuberosity Osteotomy for Total Shoulder Arthroplasty.
- Long head of the biceps pathology as a cause of anterior shoulder pain after shoulder arthroplasty.
- The role of concomitant biceps tenodesis in shoulder arthroplasty for primary osteoarthritis: results of a multicentric study.
- Biomechanical Comparison of Lesser Tuberosity Osteotomy Versus Subscapularis Tenotomy in Total Shoulder Arthroplasty
- Subscapularis release in shoulder replacement determines structural muscular changes
- subscapularis anatomy: mobilization (360 deg release):
- mobility of the subscapularis can be limited by adhesions to conjoined muscles, coracoid, glenoid, and capsule;
- releases are required order to liberate subscapularis circumferentially about its long axis;
- muscle should be fully mobilized off of the anterior glenoid;
- is detached from its insertion on lesser tuberosity and is incised together with the underlying anterior aspect of capsule (provides a thicker and
stronger structure for reattachment);
- adhesions from the base of the coracoid process are released, and the entire anterior aspect of the capsule is excised;
- double spike homan retractor is then placed on anterior glenoid and is levered off of it to provide anterior retraction;
- this homan retractor can be anchored to the Charnley retractor w/ a bone clamp;
- deep exposure is not complete until the shoulder can be easily externally rotated without having to torque on the humerus;
- references:
- Subscapularis Muscle Function and Structure After Total Shoulder Replacement with Lesser Tuberosity Osteotomy and Repair.
- Clinical, Radiographic, and Ultrasonographic Comparison of Subscapularis Tenotomy and Lesser Tuberosity Osteotomy for Total Shoulder Arthroplasty.
- Long head of the biceps pathology as a cause of anterior shoulder pain after shoulder arthroplasty.
- The role of concomitant biceps tenodesis in shoulder arthroplasty for primary osteoarthritis: results of a multicentric study.
- Biomechanical Comparison of Lesser Tuberosity Osteotomy Versus Subscapularis Tenotomy in Total Shoulder Arthroplasty
- Subscapularis release in shoulder replacement determines structural muscular changes
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