Some surgeons perform lateralization in a reverse shoulder total to increase stability, improve strength, and reduce the scapular notch.
This approach has the potential to cause unwanted contact between tuberosity and undersurface of acromion during abduction of the arm.
The authors of Subacromial notching after reverse total shoulder arthroplasty suggest that damage to the acromion may be caused by abduction impingement after reverse total shoulder arthroplasty (RSA) with a lateralized design. They reviewed the medical records of 125 patients who underwent RSA with the design shown below
The researchers defined subacromial nodding (SaN), as subacromial damage that is observed during the final post-operative follow-up, but not visible on X-rays three months later. SaN was observed in 12.8% (16/125) enrolled patients. The greater postoperative humeral offset (HL) is a risk for subacromial cutting.
The VAS and ASES scores at the final follow-up were significantly worse in patients with subacromial notching.
Comment: The greater tuberosity can be in contact with the acromion, which can reduce the abduction range and weaken the acromion.
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