Subscapularis integrity, function and EMG/nerve conduction study findings following reverse total shoulder arthroplasty

• Main Authors: Michael Khazzam, MD, Bryan Reyes, MD, Amy Phelan, MD, Stephen Gates, MD
• Format: Article
• Language: English
• Published: Elsevier 2020-09-01
• Series: JSES International
• Subjects: Reverse total shoulder arthroplasty; subscapularis; electromyography; nerve conduction study; patient-reported outcomes; shoulder arthroplasty
• Online Access: http://www.sciencedirect.com/science/article/pii/S2666638320300414

Background: During reverse total shoulder arthroplasty, the functionality of the subscapularis remains unknown. The purpose of this study was to determine the integrity and function of the repaired subscapularis after reverse total shoulder arthroplasty using ultrasound, electromyography (EMG), and nerve conduction studies (NCS) to assess postoperative tendon healing, muscle, and nerve function. Materials and methods: Patients who underwent reverse total shoulder arthroplasty and repair with minimum 6-month follow-up were included in the study. Patient-reported outcome, physical examination, ultrasound examination of the subscapularis tendon, subscapularis EMG, and lower subscapular NCS were performed. In addition, contralateral subscapularis ultrasound, EMG, and lower subscapular nerve nerve NCS were performed to establish normative values (abnormal defined at >20% increased latency or >50% decreased amplitude). Phi coefficients of association and point biserial coefficients were used to correlate the ultrasound examination, EMG, and NCS results with the functional outcomes. Results: A total of 20 patients were included. Four patients had abnormal but intact subscapularis tendons on ultrasound. Nine patients had abnormal lower subscapular NCS compared with the contralateral shoulder. All patients had normal subscapularis EMGs. No significant correlation was found between the ultrasound and NCS results. No significant correlations were found between the ultrasound or the NCS results and any of the independent outcome variables. Conclusion: This study demonstrates that the subscapularis remains neurologically functional after reverse total shoulder arthroplasty, based on EMG and NCS findings. Although side-to-side differences in lower subscapular NCS were identified in 45% of the postoperative shoulders, these abnormalities did not correlate with functional outcomes.