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Operative Treatment of Irreparable Rupture of the Subscapularis*† by MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD J Bone Joint Surg Am Volume 79(5):722-31 May 1, 1997 ©1997 by The Journal of Bone and Joint Surgery, Inc.

Operative Treatment of Irreparable Rupture of the Subscapularis*† by MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD J Bone Joint Surg Am Volume 79(5):722-31

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Page 1: Operative Treatment of Irreparable Rupture of the Subscapularis*† by MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD J Bone Joint Surg Am Volume 79(5):722-31

Operative Treatment of Irreparable Rupture of the Subscapularis*†

by MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD

J Bone Joint Surg AmVolume 79(5):722-31

May 1, 1997

©1997 by The Journal of Bone and Joint Surgery, Inc.

Page 2: Operative Treatment of Irreparable Rupture of the Subscapularis*† by MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD J Bone Joint Surg Am Volume 79(5):722-31

Figs. 1 through 6: Illustrations of the operative procedure.

MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD, JR. J Bone Joint Surg Am 1997;79:722-31

©1997 by The Journal of Bone and Joint Surgery, Inc.

Page 3: Operative Treatment of Irreparable Rupture of the Subscapularis*† by MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD J Bone Joint Surg Am Volume 79(5):722-31

Fig. 2 A bone trough is made lateral to the bicipital groove in the distal half of the greater tuberosity.

MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD, JR. J Bone Joint Surg Am 1997;79:722-31

©1997 by The Journal of Bone and Joint Surgery, Inc.

Page 4: Operative Treatment of Irreparable Rupture of the Subscapularis*† by MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD J Bone Joint Surg Am Volume 79(5):722-31

Fig. 3 Stay sutures, which had been placed in the pectoralis major, are passed into the bone trough and out through the cortical drill-holes.

MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD, JR. J Bone Joint Surg Am 1997;79:722-31

©1997 by The Journal of Bone and Joint Surgery, Inc.

Page 5: Operative Treatment of Irreparable Rupture of the Subscapularis*† by MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD J Bone Joint Surg Am Volume 79(5):722-31

Fig. 4 The pectoralis major tendon is transferred lateral to the bicipital groove and is secured into the bone trough.

MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD, JR. J Bone Joint Surg Am 1997;79:722-31

©1997 by The Journal of Bone and Joint Surgery, Inc.

Page 6: Operative Treatment of Irreparable Rupture of the Subscapularis*† by MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD J Bone Joint Surg Am Volume 79(5):722-31

Fig. 5 An osteotome is used to detach the pectoralis minor tendon, in continuity with the coracoacromial ligament, from the superior aspect of the coracoid.

MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD, JR. J Bone Joint Surg Am 1997;79:722-31

©1997 by The Journal of Bone and Joint Surgery, Inc.

Page 7: Operative Treatment of Irreparable Rupture of the Subscapularis*† by MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD J Bone Joint Surg Am Volume 79(5):722-31

Fig. 6 The coracoacromial ligament extension of the pectoralis minor tendon is transferred across the bicipital groove and is secured into the bone trough.

MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD, JR. J Bone Joint Surg Am 1997;79:722-31

©1997 by The Journal of Bone and Joint Surgery, Inc.

Page 8: Operative Treatment of Irreparable Rupture of the Subscapularis*† by MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD J Bone Joint Surg Am Volume 79(5):722-31

Figs. 7-A through 7-D: Photographs of a forty-four-year-old man, made fourteen months after reconstruction of the right shoulder with transfer of the right pectoralis major tendon.

MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD, JR. J Bone Joint Surg Am 1997;79:722-31

©1997 by The Journal of Bone and Joint Surgery, Inc.

Page 9: Operative Treatment of Irreparable Rupture of the Subscapularis*† by MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD J Bone Joint Surg Am Volume 79(5):722-31

Fig. 7-B Active external rotation and internal rotation of the shoulders.

MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD, JR. J Bone Joint Surg Am 1997;79:722-31

©1997 by The Journal of Bone and Joint Surgery, Inc.

Page 10: Operative Treatment of Irreparable Rupture of the Subscapularis*† by MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD J Bone Joint Surg Am Volume 79(5):722-31

Fig. 7-D The finding on the lift-off test was normal.

MICHAEL A. WIRTH, and CHARLES A. ROCKWOOD, JR. J Bone Joint Surg Am 1997;79:722-31

©1997 by The Journal of Bone and Joint Surgery, Inc.