Shoulder Proprioception Following Reverse Total Shoulder Arthroplasty for Unreconstructable Upper Third Fractures of the Humerus: 2-Year Outcomes

Yasin Güler; Ahmet Keskin; Fethi Mıhlayanlar; Sevgi Atar; Bülent Karslıoğlu; Yunus İmren; Süleyman Semih Dedeoğlu

doi:10.1007/s43465-022-00769-3

Shoulder Proprioception Following Reverse Total Shoulder Arthroplasty for Unreconstructable Upper Third Fractures of the Humerus: 2-Year Outcomes

Indian J Orthop. 2022 Nov 3;56(12):2245-2252. doi: 10.1007/s43465-022-00769-3. eCollection 2022 Dec.

Authors

Yasin Güler¹, Ahmet Keskin¹, Fethi Mıhlayanlar¹, Sevgi Atar², Bülent Karslıoğlu¹, Yunus İmren¹, Süleyman Semih Dedeoğlu¹

Affiliations

¹ Department of Orthopedics and Traumatology, Prof. Dr. Cemil Tascıoglu City Hospital, Kaptan Pasa Mahallesi, Darulaceze Cad. No:25, 34384 Sisli/Istanbul, Turkey.
² Department of Physical Medicine and Rehabilitation, Prof. Dr. Cemil Tascıoglu City Hospital, Istanbul, Turkey.

Abstract

Background: Proximal humerus fractures may be comminuted in the elderly or after injury with high-energy mechanisms. Reverse total shoulder arthroplasty that may affect shoulder proprioception (rTSA) has also begun to play a part in treating acute proximal humeral fractures. In this study, the authors aimed to evaluate joint position sense (JPS) after rTSA.

Methods: Humac Norm II isokinetic device was used to evaluate the joint position sense. A joint angle was determined and the ability of the patient to create the same value of the angle by the active movement was evaluated. The difference between the pre-determined angle and the patient's measured angle was recorded. For proprioceptive sense, the initial position was 0° and the determination position was 30°, 60°, and 90° for flexion and abduction, and 15° and 30° for internal rotation and external rotation.

Results: While both the mean Constant and ADLEIR scores did not differ between non-operated and operated sides, the mean proprioception differences in all flexion (30°, 60°, and 90°), abduction (30°, 60°, and 90°), internal rotation (15° and 30°), and external rotation (15° and 30°) were significantly higher in the operated side than that in non-operated side (p < 0.01 for each pairwise comparison).

Conclusion: Reverse total shoulder arthroplasty (rTSA) treatment, which has increasingly become a surgical option in un-reconstructable proximal humeral fractures has significant adverse effects on proprioception on the operated side and may pose a risk for long-term instability, premature loosening, and prosthesis mechanical complications, in this context, well-designed prospective controlled studies are required.

Keywords: Joint position sense; Proprioception; Reverse shoulder arthroplasty; Un-reconstructable proximal humeral fractures.

© Indian Orthopaedics Association 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.