Shoulder and elbow function 2 years following long head triceps interposition flap transfer for massive rotator cuff tear reconstruction

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IntroductionPatient outcomes were determined at a minimum of 2 years following massive rotator cuff tear (≥ 5 cm2) reconstruction using a triceps brachii long head interposition flap. A physiotherapist at an independent clinic performed all measurements.Patients and methodsOf 24 total eligible patients, 19 completed pre-operative and follow-up UCLA Shoulder Scores and ASES Function Scores. Of these 19 patients, 14 who did not have co-morbidities that negatively impacted their ability to perform intense exercise underwent a comprehensive clinical examination of involved and uninvolved side shoulder and elbow active range of motion and strength (both isometric instrumented manual muscle testing and concentric isokinetic measurements).ResultsAt 2 years following surgery, pre-operative UCLA Shoulder Scores improved from 10.6 ± 3 to 27.4 ± 5 and pre-operative ASES Function Scores improved from 20.1 ± 10 to 43.2 ± 5. However, isometric involved side shoulder abductor torque was decreased by 28.2% with instrumented manual muscle testing, and concentric shoulder external rotator torque was decreased by 44.6% at 60°/s and by 53.8% at 120°/s with isokinetic testing. Isometric involved side elbow extensor torque was decreased by 39% with instrumented manual muscle testing, and concentric elbow extensor torque was decreased by 17.7% and 19.2% at 60 and 120°/s, respectively, with isokinetic testing. Including three additional patients who were contacted via telephone, the majority of patients (21 of 22, 95.4%) were satisfied with their improved shoulder function and reduced pain.ConclusionsDespite reduced pain and improved shoulder function, residual involved side shoulder abductor; shoulder external rotator and elbow extensor strength deficits were evident at 2 years following surgery. This suggests the need for more focused rehabilitation, particularly for involved side elbow extensor strengthening to further improve patient function and minimize disability.

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