Adding a Latissimus Dorsi Tendon Transfer to Reverse Shoulder Arthroplasty

Abstract

Reverse shoulder arthroplasty (RSA) in patients with concomitant pseudoparalysis of external rotation, which is loss of external rotation strength, has historically resulted in worse outcomes than in patients who can actively externally rotate their shoulder. Active external rotation combined with the elevation from a reverse shoulder facilitates many activities of daily living such as brushing teeth, fixing hair, and working overhead. In order to maximize outcomes of RSA, pseudoparalysis of external rotation should be identified preoperatively and consideration given to intraoperative tendon transfers. The combination of latissimus dorsi (LD) and teres major (TM) tendon transfers in combination with RSA has improved external rotation strength and likewise improved clinical outcome. But because this is perceived as being difficult when done with traditional techniques, it may not be done as often as needed. We present a clinical case of RSA and a reproducible technique for transfer of these tendons that highlights the presentation, surgical considerations, and postoperative course of a patient with shoulder pseudoparesis of both elevation and external rotation.