Shoulder instabilities have been classified according to the etiology, the direction of instability, or on combinations thereof. The current authors describe a classification system, which distinguishes between static instabilities, dynamic instabilities, and voluntary dislocation. Static instabilities are defined by the absence of classic symptoms of instability and are associated with rotator cuff or degenerative joint disease. The diagnosis is radiologic, not clinical. Dynamic instabilities are initiated by a trauma and may be associated with capsulolabral lesions, defined glenoid rim lesions, or with hyperlaxity. They may be unidirectional or multidirectional. Voluntary dislocation is classified separately because dislocations do not occur inadvertently but under voluntary control of the patient.

Classification of glenohumeral joint instability.

Repair of massive rotator cuff tears is technically difficult but often feasible. Technical and biological challenges to a successful repair include inelastic poor-quality tendon tissue, scarring, muscle atrophy, and fatty infiltration.

Fatty infiltration of the involved rotator cuff muscles has been identified as an important negative prognostic factor for the outcome after repair of massive rotator cuff tears.

Tendon transfer is a good option for young patients and manual laborers with an irreparable massive rotator cuff tear.

Arthroplasty can be considered for the treatment of symptomatic massive rotator cuff tears in patients who have glenohumeral arthritis.

Massive Tears of the Rotator Cuff

Purpose: Our objective was to evaluate the preliminary results of 25 consecutive arthroscopic subscapularis tendon repairs. Type of Study: Case series. Methods: All 25 shoulders had longer than 3 months follow-up, with an average of 10.7 months (range, 3 to 48 months). The average age was 60.7 years (range, 41 to 78 years). The average time from onset of symptoms to surgery was 18.9 months (range, 1 to 72 months). The shoulders were evaluated using a modified UCLA score, Napoleon test, lift-off test, radiographs, and magnetic resonance imaging (MRI). Indications for surgery included clinical and/or MRI evidence of a rotator cuff tear. An arthroscopic suture anchor technique devised by the senior author (S.S.B.) was used for repair. Results: UCLA scores increased from a preoperative average of 10.7 to a postoperative average of 30.5 ( P P =.0016). Eight of 9 patients with a positive Napoleon test had complete tears of the subscapularis. All 7 patients with a negative Napoleon test had a tear of the upper half only. The lift-off test could not be performed reliably due to pain or restricted motion in 19 of the 25 patients. Eight patients had isolated tears of the subscapularis. The remaining 17 patients had associated rotator cuff tears with an average total tear size of 5 × 8 cm. Ten patients had proximal migration of the humerus preoperatively. Eight of these 10 patients had durable reversal of proximal humeral migration following surgery. These 8 patients improved their overhead function from a preoperative "shoulder shrug" with attempted elevation of the arm to functional overhead use of the arm postoperatively. Conclusions: (1) The senior author has been able to consistently perform arthroscopic repair of torn subscapularis tendons, with good and excellent results, in 92% of patients. (2) The Napoleon test is useful in predicting not only the presence of a subscapularis tear, but also its general size. (3) Combined tears of the subscapularis, supraspinatus, and infraspinatus tendons are frequently associated with proximal humeral migration and loss of overhead function. Arthroscopic repair of these massive tears can produce durable reversal of proximal humeral migration and restoration of overhead function. Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 5 (May-June), 2002: pp 454–463

Arthroscopic subscapularis tendon repair: Technique and preliminary results

http://lib.ajaums.ac.ir/booklist/1-s2.0-S105827461300579X-main.pdf

Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion

Background: Chronic tears of the subscapularis tendon with or without associated tears of the supraspinatus and infraspinatus tendons may lead to pain and dysfunction of the shoulder. If conservative treatment fails and repair of the musculotendinous unit is impossible, transfer of the pectoralis major tendon can be attempted to substitute for lost subscapularis function.

Methods: Twenty-eight patients underwent a total of thirty consecutive pectoralis major transfers at an average age of fifty-three years. There were twelve isolated subscapularis tears and eighteen subscapularis tears associated with a tear of the supraspinatus or the supraspinatus and infraspinatus. All patients were examined clinically and with standard radiographs.

Results: The mean relative Constant score increased from 47% preoperatively to 70% at an average of thirty-two months postoperatively (p < 0.0001). The mean Constant scores for pain (p = 0.0009) and activities of daily living (p < 0.0001), the range of forward flexion (p < 0.05), and abduction strength (p = 0.001) also improved. Thirteen patients (14 shoulders) were very satisfied, ten patients (eleven shoulders) were satisfied, two patients (two shoulders) were disappointed, and three patients (three shoulders) were dissatisfied with the result. The average subjective shoulder value increased from 23% preoperatively to 55% postoperatively (p = 0.0009). In patients with a massive tear, the outcome was less favorable when the torn supraspinatus tendon was irreparable, as determined preoperatively or intraoperatively, than when it was reparable (average relative Constant scores, 49% and 79%, respectively; p = 0.002).

Conclusions: Pectoralis major transfer results in improvement for patients with an irreparable subscapularis tear with or without an associated reparable supraspinatus tear. If an irreparable subscapularis tear is associated with an irreparable supraspinatus tear, the results are less favorable, and pectoralis major transfer may not be warranted.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

Outcome of Pectoralis Major Transfer for the Treatment of Irreparable Subscapularis Tears

Background: The clinical diagnosis of a tear of the subscapularis tendon is difficult, and the resulting delays frequently cause a major time-lapse before repair is attempted. Diagnostic delay often means that surgical repair is no longer possible. In twelve patients who had an irreparable tear of the subscapularis tendon, the superior one-half to two-thirds of the tendon of the pectoralis major muscle was used as a substitute for the subscapularis tendon. In order to adapt the orientation of the transferred muscle to that of the subscapularis, it was routed behind the conjoined tendon of the coracobrachialis muscle and the short head of the biceps to the lesser tuberosity. 

Methods: The operations were performed between May 1993 and June 1997. The average age of the twelve patients was sixty-five years old (range, forty-nine to eighty-one years old). Eight patients had an isolated rupture of the subscapularis tendon, and four had a concomitant lesion in the form of either a partial or a complete rupture of the supraspinatus tendon. The dominant symptoms were anterior shoulder pain and weakness that had responded poorly to nonoperative therapy. Four patients also had signs of recurrent anterior instability. 

Results: After an average follow-up interval of twenty-eight months (range, twenty-four to fifty-four months), nine of the twelve patients assessed the final result as excellent or good; three, as fair; and none, as poor. Pain was reduced, with the score improving from an average of 1.7 points (of a maximum of 15 points) preoperatively to an average of 9.6 points postoperatively. The patients' subjective functional evaluation improved from an average score of 20 points preoperatively to an average of 63 points postoperatively. The average functional rating with use of the Constant and Murley score increased from 26.9 to 67.1 percent of normal. All four preoperatively unstable shoulders were stable at the time of the latest follow-up. 

Conclusions: This repair technique can be recommended as a reconstructive procedure for elderly patients who have an irreparable tear of the subscapularis tendon.

Transfer of the Pectoralis Major Muscle for the Treatment of Irreparable Rupture of the Subscapularis Tendon

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

W. Matschi

Author Tools

Chat about Author

Papers

Transfer of the Pectoralis Major Muscle for the Treatment of Irreparable Rupture of the Subscapularis Tendon