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

Background: Two different 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. Materials and methods: All patients 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. Results: A total 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. Conclusion: Our results 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. Level of evidence: Level III, Retrospective Case-Control Study, Treatment Study. (C) 2001 Journal of Shoulder and Elbow Surgery Board of Trustees.