The Functional Outcomes Of Patients After Scapulectomy
Pierce K

Purpose:  This descriptive study reports the impairments and functional outcomes of subjects status post total or partial scapulectomy.  It describes their compensatory strategies.  Two case studies are reported.

Subjects:  10 subjects at least 2 years status post scapulectomy (2 total and 8 partial) with no active disease and no radiation or chemotherapy within 6 months.  Subjects were classified by the Malawer's Classification of shoulder girdle resection.

Methods:  Two hour evaluation by one examiner including active/passive range of motion and isometric strength testing with a Nicholas hand held dynamometer.  Self-report of function and pain were measured by a modified Arthritis Impact Measurement Scales 2 questionnaire.  Seven observed functional tasks were videotaped and scored.

Results: There was a significant difference between the involved and uninvolved extremity for passive flexion, abduction and external rotation and active elevation, extension and external rotation.  Subjects who had partial scapulectomies with intact rotator cuff had greater strength (range from 8.7-32.8 kg.) than subjects who had partial or total scapulectomies with resection of their rotator cuffs (range 0.5-19.8 kg.).  The social activity (4.2) and level of tension( 41.5) categories of the AIMS 2 had the higher mean scores.  Hand and finger function (0.7), mobility (0.45), self care tasks (0.19) and household tasks (0.38) had the lower mean scores on the AIMS 2.  The mean arm function score was 2.2.  Scores for pain ranged from 0-8.  One subject with an outlying pain score of 8 accounts for the high standard deviation of 2.48.  Scores for the observed unilateral tasks with the involved upper extremity ranged from 0-3.  Scores for observed bilateral tasks ranged from 1-3. 

Conclusions:  Overall scores of the AIMS 2 were low which represents a higher functional status and health.  Subjects have good functional ability despite their loss of ROM and strength.  An intact rotator cuff was associated with higher active ROM, strength and use in overhead activities than subjects with resected rotator cuffs.  Subjects who had their own rotator cuff resected used compensatory strategies to accomplish overhead tasks.

Clinical Relevance:  This study assists the medical community to accurately provide potential scapulectomy patients with information regarding their expected functional outcomes.  The functional outcome information could help guide physical therapy treatment following scapulectomy to maximize the rehabilitation potential and assist in determining reasonable goals.  It also assists with determining if a patient who has already had the procedure has actually achieved their maximal functional ability.