In which scenario would deltoid insufficiency be a critical consideration for procedure choice?

Deltoid insufficiency is a crucial consideration in reverse total shoulder arthroplasty (RTSA) procedures because the deltoid muscle plays a vital role in shoulder function following the surgery. In RTSA, the design and mechanics of the implant require adequate functioning of the deltoid for effective shoulder elevation and mobility, as this procedure compensates for the loss of rotator cuff function.

When deltoid insufficiency is present, it may lead to poor outcomes postoperatively, primarily due to the muscle's inability to provide sufficient stability and motion during rehabilitation. The RTSA is typically indicated in patients with rotator cuff arthropathy or irreparable rotator cuff tears where the deltoid is relied upon heavily for shoulder movement. Thus, the surgical technique and implant selection may need to be adjusted to address or accommodate this issue, making it a critical consideration in the choice of procedure.

In contrast, arthroscopic debridement, shoulder stabilization techniques, and physical therapy protocols do not intrinsically rely on the deltoid's integrity to the same extent as RTSA. These procedures are often focused on different pathologies or functions within the shoulder that are less dependent on the deltoid specifically. For instance, stabilization techniques might prioritize surrounding