Pearls and Tips in Shoulder Arthroplasty

There has been a dramatic growth in shoulder arthroplasty worldwide over the past 10 years.An organized approach to the preoperative evaluation and careful attention to key technical steps can improve patient outcomes and minimize complications in both the primary and revision setting. PREOPERATIVE EVALUATION HistoryIt is important to understand the primary complaint of the patient-is it pain, weakness, or loss of motion?Additionally, one should inquire about the patient's occupation and recreational activities.This will help with understanding the demands the patient will place on the shoulder replacement.A comprehensive understanding of prior treatment is important including injections, therapy, and prior surgery.Understanding the specific type of prior surgery is important including a history of prior shoulder stabilizations for shoulder instability that can significantly distort the anatomy.It is important to recognize if the patient had any prior problems with wound heal-ing after prior surgery.A patient may recall a history of a "stitch abscess" or use of antibiotics after prior surgery.This should alert the surgeon about potential low-grade infection.In patients with a history of inflammatory arthritis it is useful to know if other joints are involved or have been replaced including the elbow.It is also essential to get a general sense of the emotional profile of the patient and their ability to conform with postoperative rehabilitation and restrictions following the shoulder replacement. Physical ExaminationA systematic examination includes attention to the cervical spine and a neurovascular examination.In patients with history of prior surgery, inspection can reveal muscle atrophy and deltoid deficiency.One examines for shoulder range of motion including active and passive abduction, external rotation, and internal rotation.Strength is tested in flexion, abduction, external rotation, as well as internal rotation.Deltoid function is evaluated by checking the anterior, lateral, and posterior heads of the deltoid muscle.There are certain physical examination signs that are helpful to note including the Gerber lift off sign and abdominal compression test to assess for subscapularis function and the Hornblower sign for the status of the posterior rotator cuff. Preoperative Imaging Plain radiographs should include at minimum an anteriorposterior (AP) view in external rotation, AP view in inter- Pearls and Tips in Shoulder Arthroplasty