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Excessive retraction on the deltoid muscle during a delto-pectoral approach
2%
96/4239
Palpation of the rotator cuff insertion prior to humeral head resection
0%
21/4239
A humeral cut with 30 degrees of retroversion
7%
311/4239
Excessive bone removal with the humeral neck osteotomy
75%
3177/4239
A humeral cut with 45 degrees of inclination
14%
593/4239
Select Answer to see Preferred Response
The rotator cuff tendons can be inadvertantly cut or detached during a TSA if the head cut is made either too distally or in excessive retroversion. Pearl et al studied the placement of humeral component position during TSA by studying 21 cadaveric specimens. Their results supported that retroversion of the proximal humerus is highly variable, ranging from 10 degrees to 55 degrees and mean of 29.8 degrees. They recommend anatomic reconstruction of the retroversion angle based on patient anatomy. They also stress palpation of the rotator cuff insertion prior to humeral head resection to avoid inadvertant cuff injury. Illustrations A shows example of an appropriate osteotomy which is made proximal to both the greater and less tuberosities. Illustration B shows the footprint of the rotator cuff insertion relative to the correct humeral cut during a TSA. Incorrect Answers: Choice 1- Excessive retraction on the deltoid muscle could cause injury to the axillary nerve, but will not injure the rotator cuff. Choices 2- This step is encouraged to spare the rotator cuff insertions before humeral head osteotomy Choice 3- A head cut in 30 degrees of retroversion is normal Choice 5- Excessive inclination may take too much medial bone, but if appropriately placed, would not risk injuring the rotator cuff insertion.
4.0
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