Reverse Delta-III Total Shoulder Replacement Combined with Latissimus Dorsi Transfer by Christian Gerber, Scott D. Pennington, Erich J. Lingenfelter, and.

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Presentation transcript:

Reverse Delta-III Total Shoulder Replacement Combined with Latissimus Dorsi Transfer by Christian Gerber, Scott D. Pennington, Erich J. Lingenfelter, and Atul Sukthankar J Bone Joint Surg Am Volume 89(5): May 1, 2007 ©2007 by The Journal of Bone and Joint Surgery, Inc.

A sixty-five-year-old woman with a massive rotator cuff tear involving the supraspinatus, infraspinatus, and teres minor associated with pseudoparesis of elevation and of external rotation. Christian Gerber et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Pseudoparesis of external rotation. Christian Gerber et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Two years after reverse total shoulder arthroplasty without a latissimus dorsi transfer, overhead elevation is 100° but the arm remains in full internal rotation, preventing more anterior elevation. Christian Gerber et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

At two years, active external rotation is not improved. Christian Gerber et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

With the patient in the beach-chair position, the arm draped free, and the arm elevated and internally rotated, a curved incision is made lateral to the axillary crease. Christian Gerber et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

No remaining rotator cuff is attached to the humerus. Christian Gerber et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

The humeral head is resected at the level of the anatomical neck and brought into external rotation. Christian Gerber et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

A seventy-one-year-old woman with a massive rotator cuff tear involving the supraspinatus, infraspinatus, and teres minor. Christian Gerber et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

Two years after a reverse total shoulder arthroplasty and a concomitant latissimus dorsi transfer, elevation has been fully restored and automatic external rotation also has been restored. Christian Gerber et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.

The patient can control external rotation of the abducted arm with the transferred latissimus dorsi, evidence of at least partial restoration of teres minor function. Christian Gerber et al. J Bone Joint Surg Am 2007;89: ©2007 by The Journal of Bone and Joint Surgery, Inc.