Muscle activation variability in relation to functional internal rotation in reverse total shoulder arthroplasty

The use of reverse total shoulder arthroplasty (rTSA) has increased in recent years, thanks to its application versatility. Despite this increase, there exists a significant variability in postoperative functional internal rotation (fIR), affecting patients' daily life independence. Previous literature investigated patient-related, kinematical, and surgical parameters to understand the variability in fIR outcome. This study aimed to investigate the role of muscle activation patterns in the fIR outcome variability.

Muscle activation patterns are correlated with fIR levels after rTSA.

A prospective study included 16 pain-free rTSA patients (Trabecular Metal Reverse shoulder system; Zimmer Biomet) at a minimum of 1 year after surgery. Patients were instructed to perform the hand-to-back movement in triplicate, while kinematical patterns were captured using reflective markers. A combination of surface and intramuscular electrodes documented muscle activations which were normalized using maximal isometric voluntary contraction trials. During these maximal isometric voluntary contraction trials, a dynamometer measured internal rotation strength. Maximal fIR level of each trial was determined using the normalized distance between the hand dorsum and C7 vertebra. Their kinesiophobia was scored based on the Tampa-17 scale. Spearman's Rank correlation coefficients (R_s) were computed for Tampa score, internal rotation strength, and root-mean-squared muscle activations with fIR levels. Statistical significance (∗) was detected at P < .05.

Posterior deltoid, upper and lower trapezius, and teres major had the highest activation among all muscles in high fIR level patients. A negative correlation was detected between fIR level and muscle activations of several functionally different muscles, being the pectoralis major (∗), middle and lower trapezius, serratus anterior, teres minor (∗), and latissimus dorsi (∗). Tampa scoring weakly correlated with fIR level (R_s = -0.32, P = .025), while internal rotation strength showed a slight positive correlation (R_s = 0.28, P = .054).

Lower-level patients tended to have an overactivation of certain shoulder girdle muscles leading to a limited fIR outcome. Muscle activations of some principal shoulder muscles are correlated with fIR outcome. Muscle activation patterns revealed that mainly the posterior deltoid, upper and lower trapezius, and teres major muscles are essential to reach high fIR levels. Finally, an increased kinesiophobia and decreased internal rotator strength were correlated with lower fIR outcomes.