Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Reverse shoulder arthroplasty for corticosteroid-induced deltoid myopathy in a patient with systemic lupus erythematosus: a case report

  • Bayram, Serkan (Department of Orthopedics and Traumatology, Istanbul University Faculty of Medicine) ;
  • Ersen, Ali (Department of Orthopedics and Traumatology, Istanbul University Faculty of Medicine)
  • Received : 2021.04.11
  • Accepted : 2021.06.14
  • Published : 2021.09.01
Download PDF
⟨ Previous Next ⟩

Abstract

A 50-year-old woman who had been previously diagnosed with systemic lupus erythematosus consulted our clinic for pain and weakness in her right shoulder. On examination, she had an atrophied deltoid muscle, a painful right shoulder on movement, and a tender mass in the deltoid area. The patient was diagnosed with corticosteroid-induced deltoid myopathy, shoulder pain, and loss of range of motion that did not resolve with conservative treatment. We decided to perform reverse shoulder arthroplasty. No complications were observed at the last follow-up visit at 3 years postoperative. Unlike deltoid insufficiency that results from axillary nerve injury, deltoid myopathy due to corticosteroid use contains intact fibers,. Therefore, we increased the effectivity of the remaining deltoid fibers by extending the moment arm of the anterior fibers using reverse shoulder arthroplasty and achieved reliable improvements in clinical symptoms and function without increasing the risk of dislocation.

Keywords

References

  1. Furst DE, Amato AA, Iorga SR, Gajria K, Fernandes AW. Epidemiology of adult idiopathic inflammatory myopathies in a U.S. managed care plan. Muscle Nerve 2012;45:676-83. https://doi.org/10.1002/mus.23302
  2. Barnes PR, Dalakas MC, Jones DH, Palace JA, Rose MR. Myopathies in clinical practice. Oxford: Isis Medical Media; 2003. p. 59-83.
  3. Jakati S, Rajasekhar L, Uppin M, Challa S. SLE myopathy: a clinicopathological study. Int J Rheum Dis 2015;18:886-91. https://doi.org/10.1111/1756-185X.12592
  4. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures: pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 1994;(304):78-83.
  5. Hamada K, Fukuda H, Mikasa M, Kobayashi Y. Roentgenographic findings in massive rotator cuff tears: a long-term observation. Clin Orthop Relat Res 1990;(254):92-6.
  6. Ladermann A, Walch G, Denard PJ, Collin P, Sirveaux F, Favard L, et al. Reverse shoulder arthroplasty in patients with pre-operative impairment of the deltoid muscle. Bone Joint J 2013; 95:1106-13. https://doi.org/10.1302/0301-620X.95B8.31173
  7. Schneeberger AG, Muller TM, Steens W, Thur C. Reverse total shoulder arthroplasty after failed deltoid flap reconstruction. Arch Orthop Trauma Surg 2014;134:317-23. https://doi.org/10.1007/s00402-013-1908-1
  8. Dosari MA, Hameed S, Mukhtar K, Elmhiregh A. Reverse shoulder arthroplasty for deltoid-deficient shoulder following latissimus dorsi flap transfer: case report. Int J Surg Case Rep 2017;39:256-9. https://doi.org/10.1016/j.ijscr.2017.08.042
  9. Goel DP, Ross DC, Drosdowech DS. Rotator cuff tear arthropathy and deltoid avulsion treated with reverse total shoulder arthroplasty and latissimus dorsi transfer: case report and review of the literature. J Shoulder Elbow Surg 2012;21:e1-7.
  10. Essilfie A, McKnight B, Heckmann N, Rick Hatch GF 3rd, Omid R. Revision reverse total shoulder arthroplasty in a patient with preoperative deltoid insufficiency: a case report. J Shoulder Elbow Surg 2017;26:e232-5. https://doi.org/10.1016/j.jse.2017.03.031