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J Shoulder Elbow Surg. 2017 Sep;26(9):1603-1608. doi: 10.1016/j.jse.2017.02.013. Epub 2017 Jun 7.

Healing and functional outcome of a subscapularis peel repair with a stem-based repair after total shoulder arthroplasty.

Author information

The Cleveland Shoulder Institute, Beachwood, OH, USA. Electronic address:
Southern Oregon Orthopedics, Medford, OR, USA; Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA.
The Cleveland Shoulder Institute, Beachwood, OH, USA.
Rush University Medical Center, Chicago, IL, USA.
The Orthopedic Clinic Association, Phoenix, AZ, USA; Department of Orthopedic Surgery, Banner University Medical Center, Phoenix, AZ, USA.



The purpose of this study was to evaluate functional outcome and healing of a subscapularis peel with a stem-based repair after total shoulder arthroplasty (TSA). The hypothesis was that the repair would lead to subscapularis healing in the majority of cases.


A prospective analysis was performed on a consecutive series of TSAs. Range of motion and functional outcome were assessed according to American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, Simple Shoulder Test, and visual analog scale scores at a minimum follow-up of 1 year. Belly-press and lift-off tests were also performed. An ultrasound evaluation assessed subscapularis healing at final follow-up.


At a mean follow-up of 15 months, 60 patients (mean age, 64 years) were examined. Mean forward flexion improved from 115° to 137°. External rotation at the side improved from 27° to 52°, and internal rotation improved from L4 to L2 (P < .05). American Shoulder and Elbow Surgeons score improved from 34.3 to 79.8 (P < .001). Likewise, the Single Assessment Numeric Evaluation and Simple Shoulder Test scores showed significant improvement from 33.1 to 85.3 and 4.3 to 10.2, respectively (P < .001). The visual analog scale score for pain decreased from 5.8 to 0.7 (P < .001). On ultrasound examination, the subscapularis was healed intact in 55 cases (91.7%), attenuated in 3 cases (5%), and torn in 2 cases (3.3%).


A stem-based repair of a subscapularis peel after TSA leads to functional improvement in the majority of cases with >90% postoperative healing of the subscapularis.


Total shoulder arthroplasty; short-stem shoulder implant; shoulder arthritis; shoulder functional outcomes; subscapularis peel; ultrasound evaluation

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