Shoulder replacement surgery can be performed with a small anterior incision involving subscapularis tendon manipulation.

“so um what uh well you know what let me I'm going to draw another picture real fast that will show what a arthritic shoulder looks like and then that'll help yeah under it small so in the little picture to the left I've drawn an arthritic shoulder not well but I've drawn it to make a point so it kind of the head kind of flattens out you have no space in there at all you get a bone spur down here you get some spurring around the perimeter of the glenoid and all of that conspires to greatly diminish the motion of the shoulder and and cause pain so they get two there's two reasons they come dysfunction because they can't do what they desperately want to do whether it's recreational or work sometimes and number two pain either one of those is a solid indication for it when the radiographic findings are there and if we do that then what we do is is go in and now we do these through incision that big you know uh wow it's just a very small anterior incision anterior incision and take down part or all or part or most of the subscapularis the 10 in the front we have to have a window in now we can work through the interval the space between the super space and the subscapularis but only if it's a more limited replacement and but anyway you take some of that off you have a window there you have retractors in and you use an oscillating saw and just take that arthritic head off of there like that and all the bone spurs then with that space that that creates you use another retractor push the head the shaft and what's left of the show what's left of the shaft away and then you get in and work on the glenoid and you ream that down to where it's all smooth get the bone spurs out of the perimeter and then put in this little high density polyethylene this is that ultra high molecular weight polyethylene exactly very durable I mean do you wear so it's the same thing that's the tibial Plateau exactly exactly the same it's great and then these have little pegs you drill holes you maybe usually cement those in just a little bit uh some are press fit but usually cement it in a little bit just that part and it just it's a perfect nice new Teflon surface for then this Cobalt chromium or whatever alloy it is uh for the head and you the you know the bone has a central core and you clean that out get it fixed and this is press fit we don't cement these anymore unless people have really bad bone or real Vision just press fitted into that kinsellus bone and uh and it's super solid the rotator cuff is kept intact the rotator cuff is still intact on top you're working around that reattach the subscapularis and so give if you're going to transect the subscapularis what is the least traumatic place to do it it completely within the muscle I'm assuming yeah no no actually on the tendon where it inserts oh you have to because you're reattaching yeah yeah yeah that makes sense and uh we leave a sleeve so we can suture tendon to tendon yeah but then we also put this heavy suture into bone so you get bone reinforcement and you've got 10 and the 10 in healing you also by doing that you maintain the normal length so yeah so the only thing I mean this is oversimplification but the biggest thing this person is missing is a labrum yes yeah and they don't really need it so what stabilizes this joint the fact that it's arthritic it's already stabilized itself unless it's a weird dislocating joint which is a different entity and you have to address that differently for the garden variety one they've already kind of stiffened up all the tissues even the so what does their capsule look like when you go in typically thick it's super thick super thick we resect some of it even it's so thick okay it's kind of space occupying almost and what is this person's in in a good case yeah what is the limitation on this person a year out from surgery yeah really nothing except heavy weights like I don't want people doing bench press I don't want them doing the you know Iron Cross type things and they're usually not I had one patient can they throw a ball yeah yeah I think through a ball no they can play catch I'm sorry catch with their grandkids and play catch with their grandkids for sure uh they can play tennis they can play tennis and play tennis and play golf they shoot a basketball yeah can”

“the rotator cuff is kept intact the rotator cuff is still intact on top you're working around that reattach the subscapularis in front given if you're going to transect the subscapularis what is the least traumatic place to do it completely within the muscle I'm assuming yeah no no actually on the tendon where it inserts oh you have to because you're reattaching it yeah yeah that makes and uh we leave a sleeve so we can suture tendon to tendon but then we also put this heavy suture into bone so you've got bone reinforcement and you've got tendon attendant healing you also by doing that you maintain the normal length”

“and we do these through incision that big you know it's just a very small anterior incision anterior incision and take down part or all or part or most of the subscapularis the tendon in the front we have to have a window in now we can work through the interval the space between the suus and the subscapularis but only if it's a more limited replacement and but anyway you take some of that off you have a window there you have retractors in and you use an oscillating saw and just take that arthritic head off of there like that and all the bone spurs”