Summary

This study aims to demonstrate the safety of a complete long head of the triceps release (LHTR) without jeopardizing patient outcomes and triceps strength.

Abstract

Introduction

Soft tissue releases and exposure are important steps to enable accurate implant placement. Circumferential release of the glenohumeral joint capsule during glenoid exposure, especially inferiorly, ensures a tether-free range of motion (ROM) in shoulder elevation. With the long head of triceps origin structurally integrated with the inferior glenohumeral capsule, its release is often necessitated in tight shoulders with inferior capsular contractures, such as in arthritis or cuff tear arthropathy. Failure to do so can impede postoperative shoulder ROM in abduction and forward flexion. An inferior tether also contributes to RSA construct instability by impeding full humeral extension in adduction. Careful release of these often tight inferior structures ensures reverse shoulder arthroplasty (RSA) construct stability and allows adequate impingement-free movement. This study aims to demonstrate the safety of a complete long head of the triceps release (LHTR) without jeopardizing patient outcomes and triceps strength.

Methods

This was a retrospective review of prospectively collected data from consecutive patients who underwent primary RSA with a long head of triceps release from January 2018 to December 2021. Patients with RSA for fracture, revision RSA, bilateral shoulder pathology, or follow-up less than 2 years were excluded. All clinical data assessed was at the 2-year postoperative time point. The primary outcome measure was triceps strength. Secondary outcomes were shoulder active ROM, Constant-Murley Score (CMS), American Shoulder and Elbow Score (ASES), and Visual Analogue Score (VAS) for pain. All variables were evaluated preoperatively and at 2 years postoperatively. Complications such as dislocation and neurovascular injuries were also noted.

Results

A total of 80 patients were included in this study, with a mean age of 71+¬6 years. There was equal distribution of male and female patients, with 49 right and 31 left shoulders operated on. At the 2-year post-operative time point, the mean triceps strength of the operated shoulder was 6.3 kg, which was comparable to the preoperative strength of 6 kg. There was improvement in all planes of shoulder active ROM (forward flexion 48 to 164 degrees, lateral elevation 43 to 158 degrees, ER 21 to 53 degrees, IR 24 to 62 degrees), VAS (4 to 0), ASES (56 to 93), and CMS (35 to 77) at 2 years postoperatively. There was no dislocation or injury to the neurovascular structures inferior to the glenoid.

Conclusion

Our initial study shows that releasing the long head of the triceps does not affect postoperative triceps strength. The CMS, ASES, VAS, and active ROM were satisfactory at 2 years postoperatively. This technique is found to be safe, with no neurovascular complications noted intraoperatively and postoperatively. This is provided that meticulous dissection and attention to neurovascular structures are observed while performing the release. Future research aims to investigate the radiological outcomes, such as scapular notching and heterotopic ossification, following RSA with triceps release.