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

摘要

INTRODUCTION: Patient outcomes were determined at a minimum of 2 years following massive rotator cuff tear ( >/= 5 cm(2)) reconstruction using a triceps brachii long head interposition flap. A physiotherapist at an independent clinic performed all measurements. PATIENTS AND METHODS: Of 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). RESULTS: At 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 decreasedby 28.2 with instrumented manual muscle testing, and concentric shoulder external rotator torque was decreased by 44.6 at 60 degrees /s and by 53.8 at 120 degrees /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 degrees /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. CONCLUSIONS: Despite 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.