Subscapularis tenotomy versus lesser tuberosity osteotomy during total shoulder replacement: a comparison of patient outcomes

Background fferent techniques to release the subscapularis during total shoulder replacement (TSR) have been described: tenotomy and osteotomy. We review the clinical outcomes of a sequential series of patients in whom a TSR for primary osteoarthritis had been performed by either technique at our institution. Subscapularis function was tested by a new graded belly-press test. als and methods tients who underwent surgery between January 2002 and January 2010, and met the eligibility criteria, were included for analysis. Subscapularis function was assessed postoperatively with a range of functional assessments, including the graded belly-press test and lift-off test, as well as assessment of each patient’s range of movement. s l of 36 shoulders in 36 patients were subsequently reviewed, 10 of whom underwent tenotomy and 26 of whom underwent osteotomy. Patients who had undergone osteotomy of the lesser tuberosity had a more favorable outcome overall. These patients showed a trend toward a better range of movement, although no statistical significance was shown. They had a better grade (grade 1) on the belly-press test compared with the tenotomy group (P = .026). All patients (osteotomy and tenotomy) with a grade 1 belly-press test had a better clinical outcome with data showing statistical significance. sion sults indicate that in this single-surgeon sequential series, patients who underwent osteotomy of the lesser tuberosity during TSR for osteoarthritis had a better functional outcome than those who had a subscapularis tenotomy as assessed by the graded belly-press test.