This is a Level IV case series of 39 shoulders after total shoulder arthroplasty using a lesser tuberosity osteotomy to take down the subscapularis. The question: does bone-to-bone repair heal reliably and preserve subscapularis function better than tenotomy? Patients were followed an average of 39 months with clinical tests and CT.
When you take down the subscapularis for anterior exposure in a total shoulder, how you do it changes what you can monitor afterward. A lesser tuberosity osteotomy creates a bone-to-bone repair that heals predictably and is visible on axillary radiographs and axial CT, unlike a tenotomy where you cannot easily confirm healing.
The teaching point is a warning: anatomical healing does not equal a healthy muscle. Nearly half of these shoulders showed progressive fatty infiltration even though every osteotomy united and no tendon retracted.
That uncouples two ideas residents often conflate. Fatty infiltration is not only a marker of tendon rupture and retraction. Here it progressed without either, and the authors suspect subscapular nerve injury during mobilization.
Practically, protect the axillary and subscapular nerves during release, use the belly-press and lift-off tests at follow-up, and remember that a positive belly-press tracks with worse fatty degeneration on CT.
This is a Level IV case series of 39 shoulders after total shoulder arthroplasty using a lesser tuberosity osteotomy to take down the subscapularis. The question: does bone-to-bone repair heal reliably and preserve subscapularis function better than tenotomy? Patients were followed an average of 39 months with clinical tests and CT.
When you take down the subscapularis for anterior exposure in a total shoulder, how you do it changes what you can monitor afterward. A lesser tuberosity osteotomy creates a bone-to-bone repair that heals predictably and is visible on axillary radiographs and axial CT, unlike a tenotomy where you cannot easily confirm healing.
The teaching point is a warning: anatomical healing does not equal a healthy muscle. Nearly half of these shoulders showed progressive fatty infiltration even though every osteotomy united and no tendon retracted.
That uncouples two ideas residents often conflate. Fatty infiltration is not only a marker of tendon rupture and retraction. Here it progressed without either, and the authors suspect subscapular nerve injury during mobilization.
Practically, protect the axillary and subscapular nerves during release, use the belly-press and lift-off tests at follow-up, and remember that a positive belly-press tracks with worse fatty degeneration on CT.