Shoulder Muscle Strength and Neuromuscular Activation 2 Years after Reverse Shoulder Prosthesis-An Experimental Case Control Study.

Anna Rienmüller,Hans-Kaspar Schwyzer,Andreas Eggspühler,Nicola A Maffiuletti

doi:10.3390/jcm9020365

Anna Rienmüller, Hans-Kaspar Schwyzer + Show 2 more

Open Access

https://doi.org/10.3390/jcm9020365

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Abstract

Although reverse shoulder arthroplasty (RSA) has shown successful postoperative outcomes, little is known about compensatory activation patterns of remaining shoulder muscles following RSA. The purpose of this experimental case control series was to investigate shoulder muscle strength and neuromuscular activation of deltoid and teres minor muscles 2 years after RSA. Humerus lengthening, center-of-rotation medialization, maximal voluntary strength, and electromyographic (EMG) activity were compared between the operated and the non-operated side of 13 patients (mean age: 73 years). Shoulder muscle strength was significantly lower on the operated side for external rotation (−54%), internal rotation (−20%), and adduction (−13%). Agonist deltoid EMG activity was lower on the operated side for shoulder flexion, extension, and internal and external rotation (p < 0.05). Antagonist deltoid coactivation was higher on the operated side for external rotation (p < 0.001). Large correlation coefficients were observed between shoulder adductor strength asymmetry and both center-of-rotation medialization (r = −0.73) and humerus lengthening (r = 0.71). Shoulder abduction strength and neuromuscular activation were well preserved 2 years after RSA, while persistent strength and activation deficits were observed for shoulder adduction and internal and external rotation. Additional studies are required to elucidate shoulder neuromuscular activation patterns before and after RSA to support decision making for surgical, implant design, and rehabilitation choices.

Highlights

The concept of reversed shoulder arthroplasty (RSA) was introduced in the early 90s by Grammont and Baulot, with the intent of replacing the glenoid and the humeral joint surface and optimizing deltoid muscle function in the presence of rotator cuff tear arthropathy [1]
Deltoid retensioning and COR medialization influence the biomechanical behavior of the shoulder [2] but they can affect the remaining rotator cuff and deltoid muscles in terms of tension, force distribution, and force vectors within the muscles
Post-operative shoulder abduction, flexion, and internal and external rotation ranges of motion were significantly lower for the operated than for the non-operated side (p < 0.001)

Summary

Introduction

The concept of reversed shoulder arthroplasty (RSA) was introduced in the early 90s by Grammont and Baulot, with the intent of replacing the glenoid and the humeral joint surface and optimizing deltoid muscle function in the presence of rotator cuff tear arthropathy [1]. Deltoid retensioning and COR medialization influence the biomechanical behavior of the shoulder [2] but they can affect the remaining rotator cuff and deltoid muscles in terms of tension, force distribution, and force vectors within the muscles This may chronically alter the neuromuscular function of the deltoid and of the remaining teres minor [5], potentially leading to increased fatty infiltration and reduced muscle strength. Together, these alterations can affect shoulder function and long-term clinical outcomes [6], despite a lack of evidence

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