Strength Recovery with Lateralized Reverse Total Shoulder Arthroplasty Combined with Pectoralis Major Transfer for Rotator Cuff Arthropathy with Internal Rotational Deficiency: A Case Report

Introduction: Reverse total shoulder arthroplasty (RTSA) has shown promise as a solution for individuals with rotator cuff tear arthropathy (CTA). However, RTSA has demonstrated limited improvement in internal rotation (IR) range of motion (ROM) and strength, potentially affecting patients' ability to perform essential daily tasks such as toileting, a crucial factor that significantly influences overall patient satisfaction. Case Report: A 69-year-old female patient presented with a complaint of chronic pain and weakness in her right shoulder. The patient exhibited rotator CTA with irreparable subscapularis. As the owner of a fish restaurant, the patient underwent lateralized RTSA combined with pectoralis tendon transfer. By the post-operative 1 year 6 months, the patient's strengths of forward elevation (FE) and IR had improved from 14.2N to 20.2N and from 15.4 to 26.2N, respectively. The ROM increased from 80° to 150° for FE, from 70° to 150° for abduction, from 25° to 35° for external rotation, and from L5 to L1 for IR at the back. With no significant complications, the patient was able to return to her workplace. Conclusion: Primary RTSA combined with pectoralis major tendon transfer could be a viable option for restoring both ROM and strength in FE and IR, particularly in cases of rotator CTA with irreparable subscapularis tears.