Review Question - QID 215442

Tuberosity healing following reverse shoulder arthroplasty (RSA) for fracture greatly improves external rotation.

Reverse shoulder arthroplasty is being increasingly utilized for the treatment of proximal humerus fractures. Postoperative external rotation has been linked to improved outcomes as it is essential for many activities of daily living. External rotation, especially external rotation with the shoulder at 90 degrees of abduction, is largely due to the function of the teres minor, which inserts on to the great tuberosity. Tuberosity healing has been shown to improve forward flexion, abduction, and external rotation postoperatively. Additionally, numerous implant modifications have been cited as ways to improve range of motion including a lateralized glenoid, lower neck-shaft angle, and humeral inlay designs.

Jain et al reviewed tuberosity healing as it related to functional outcomes and satisfaction following RSA for complex proximal humerus fractures in the elderly. They report that the subset of patients with greater tuberosity healing had improved forward flexion and external rotation as well as improved Constant scores. They conclude that tuberosity healing greatly improves function following RSA for fracture.

Boileau et al review whether or not it’s worth repairing the tuberosities in patients undergoing RSA for fracture. They report that all patients with “disappointing” outcomes in their study had either tuberosity nonunion or resorption. Those patients with healed tuberosities exhibited an improved range of motion, including external rotation. They conclude that reattachment and healing of the tuberosities greatly improve outcomes in patients treated with RSA for fracture.

Figures A and B are the postoperative radiographs of a patient who underwent RSA for a proximal humerus fracture with near anatomic alignment of the greater tuberosity.

Incorrect Answers:
Answer 1: Increased inferior tilt has not been shown to be related to external rotation following RSA for fracture.
Answer 2: Larger, not smaller, glenospheres improve external range of motion.
Answer 3: Glenoid lateralization improves soft tissue tensioning and range of motion.
Answer 4: High neck-shaft angles have been linked to decreased range of motion when compared to lower angled prostheses (135-degree)