Arthroscopic Conjoint Tendon Release for Painful Reverse Total Shoulder Arthroplasty

Persistent pain after reverse total shoulder arthroplasty (RTSA) is a difficult problem to manage. Anterior shoulder pain may arise from conditions, including anterior impingement, conjoint tendonitis, or coracoid fracture after RTSA. Clinical function and anterior pain may improve after release of the conjoint tendon. An open technique for conjoint tendon release has been described. The purpose of this video is to describe and illustrate a technique for arthroscopic release of the conjoint tendon after RTSA.

Patients with recalcitrant pain at the tip of the coracoid, lesser tuberosity, and conjoint tendon origin after RTSA, combined with painful internal rotation, are candidates for arthroscopic decompression and conjoint tendon release. Nonoperative management before surgical intervention can include an injection at the conjoint tendon origin, with care taken to avoid steroid injection into the shoulder joint space or in the RTSA prosthetic components. This injection may be both diagnostic and therapeutic.

The patient is positioned in the lateral or beach-chair position, depending on the surgeon's preference. Because RTSA does not have an accessible joint space, the scope is placed immediately into the subacromial space. Additional anterior, lateral, and inferolateral portals are placed with spinal needle guidance and blunt instrumentation. Debridement, cultures, coracoplasty, and conjoint tendon release are performed arthroscopically.

The conjoint tendon release technique may relieve anterior, coracoid, and lesser tuberosity pain and improve function after RTSA in appropriate patients.

Arthroscopic conjoint tendon release allows the surgeon to evaluate and manage the painful RTSA using a minimally invasive technique. Arthroscopic conjoint tendon release after RTSA provides a minimally invasive method to assess the painful RTSA and may relieve pain and improve function for patients with persistent conjoint tendonitis.

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