The effect of conjoint tendon release on pain and internal rotation following reverse total shoulder arthroplasty: a prospective randomised controlled trial

INTERVENTION: Participants in this study will be adults who are undergoing reverse total shoulder arthroplasty. The intervention is conjoint tendon release which will be performed at the same time and approach for the arthroplasty procedure. The conjoint tendon is a tendon at the front of the shoulder which is comprised of the short head of biceps and coracobrachialis tendons and attaches to a bony structure on the shoulder blade (scapula) called the coracoid. A reverse total shoulder arthroplasty is an operation performed to replace the ball and socket of the shoulder joint and swaps the position of both. Recent evidence has shown that conjoint tendon irritation can cause stiffness and pain in patients undergoing reverse total shoulder arthroplasty, so a conjoint tendon release may help resolve this issue. Releasing the conjoint tendon involves incising it during the same initial operation for reverse shoulder arthroplasty to reduce the risk of stiffness and pain. Conjoint tendon release will be performed in conjunction with the primary rTSA that patients will have already been planned for. This additional procedure does not require a separate surgical incision or approach, and should not significantly prolong the timing of surgery. The surgery will take approximately one hour and additional 20 minutes for conjoint tendon release. There are some theoretical risks which will be outlined below. Surgical risks include: Anterior instability, potential neurovascular damage Surgical technique of open conjoint tendon release does not require a new incision and it is completed within the existing anatomical field of the surgical approach. There is a theoretical risk of further bleeding and neurovascular injury from the extra procedure of incising the conjoint tendon CONDITION: Musculoskeletal ‐ Other muscular and skeletal disorders Shoulder arthritis;Reverse total shoulder arthroplasty; ; Shoulder arthritis ; Reverse total shoulder arthroplasty Surgery ‐ Surgical techniques PRIMARY OUTCOME: Anterior shoulder pain[Visual analogue scale 100mm where 0 is no pain and 100 is the worst possible imaginable pain ; 6 weeks, 3 months, 6 months and 12 months (primary timepoint) post reverse total shoulder arthroplasty surgery ] Internal rotation [Shoulder range of motion with goniometer 6 weeks, 3 months, 6 months and 12 months (primary timepoint) post reverse total shoulder arthroplasty surgery ] SECONDARY OUTCOME: Patient satisfaction[Questionnaires including visual analogue scale (VAS) for pain and stiffness respectively, Subjective Shoulder Value (SSV), American Shoulder and Elbow Surgeons (ASES) score, complication rates and reoperation rates which will be assessed from patient medical records. ‐ composite secondary outcome ; 6 weeks, 3 months, 6 months and 12 months (primary timepoint) post reverse total shoulder arthroplasty surgery ] INCLUSION CRITERIA: Patients undergoing primary rTSA for under two surgeons at Kareena Private Hospital and Strathfield Private Hospital