Teres minor muscle

Abstract: It is difficult to determine the size and localization of rotator cuff tears preoperatively. But with the special arthrographic technique, a diagnosis with about 80% accuracy was possible in 65 surgically confirmed rotator cuff tears. With this technique, 22 massive cuff tears were found in conservatively treated patients. In these patients, the plain roentgenograms obtained at the initial examination were also analyzed. The roentgenographic findings included narrowing of the acromiohumeral interval and degenerative changes of the humeral head, the tuberosities, the acromion, the acromioclavicular joint, and the glenohumeral joint. Based on these data, five roentgenographic grades of massive cuff tears were identified. Of seven patients with massive tears, which had been treated conservatively and followed for more than eight years, the roentgenographic grades advanced in five. One shoulder progressed to cuff-tear arthropathy. Based on these observations, it is proposed that the following pathogenetic mechanisms are responsible for the progressive roentgenographic changes: (1) arm elevation in activities of daily living, (2) rupture of the long head of biceps tendon, (3) the abnormal fulcrum of the humeral head against the acromion and the coracoacromial ligament, and (4) the weakness of external rotation. A massive cuff tear will progress to cuff-tear arthropathy, with each step of progression accompanied by characteristic roentgenographic changes.

Abstract: Background: Treatment of irreparable rotator cuff tears remains controversial. Latissimus dorsi transfer to the greater tuberosity has been proposed for the treatment of irreparable tears associated with severe functional impairment and chronic, disabling pain. Methods: Sixty-seven patients with sixty-nine irreparable, full-thickness tears of at least two complete tendons were managed with latissimus dorsi transfer and were reviewed clinically and radiographically after an average of fifty-three months. The study group included fifty-two men and fifteen women, with an average age of sixty-one years. Thirteen patients also had deficient subscapularis function preoperatively. Outcome measures included the Constant and Murley score and the Subjective Shoulder Value. Osteoarthritis and acromiohumeral distance were measured on standardized radiographs. Results: The mean Subjective Shoulder Value increased from 28% preoperatively to 66% at the time of follow-up (p < 0.0001). The mean age and gender-matched Constant and Murley score improved from 55% to 73% (p < 0.0001). The pain score improved from 6 to 12 points (of a possible 15 points) (p < 0.0001). Flexion increased from 104° to 123°, abduction increased from 101° to 119°, and external rotation increased from 22° to 29° (p < 0.05). Abduction strength increased from 0.9 to 1.8 kg (p < 0.0001). There was a slight but significant increase in osteoarthritic changes (from stage 0.8 to stage 1.3; p = 0.0002). In shoulders with a negative preoperative lift-off test, significant improvements were observed in terms of both function and pain, and strength doubled from 1.0 to 2.0 kg (p = 0.0001), but osteoarthritic changes progressed from stage 0.7 to stage 1.1 (p = 0.0006). In shoulders with poor subscapularis function, no improvement in these parameters was observed. Conclusions: Latissimus dorsi transfer durably and substantially improves chronically painful, dysfunctional shoulders with irreparable rotator cuff tears, especially if the subscapularis is intact. If subscapularis function is deficient, the procedure is of questionable benefit and probably should not be used. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Abstract: We studied 54 patients operated on for combined supraspinatus and infraspinatus rotator-cuff tears. The presence or absence of the dropping and hornblower's clinical signs of impaired external rotation were correlated with Goutallier stage-3 or stage-4 fatty degeneration of infraspinatus and teres minor. These grades of fatty degeneration have previously been correlated with a poorer outcome from reconstructive surgery. We found that hornblower's sign had 100% sensitivity and 93% specificity for irreparable degeneration of teres minor and the dropping sign 100% sensitivity and 100% specificity for similar degeneration of infraspinatus. In seven patients, teres minor showed hypertrophy. This muscle can give useful function for the activities of daily living in patients with rotator-cuff tears in whom it is intact.

Abstract: Background: Transfer of the latissimus dorsi tendon to the greater tuberosity of the humerus for treatment of an irreparable rotator cuff tear has been reported to yield good-to-excellent short to intermediate-term results in well-selected patients. The purpose of this study was to evaluate the long-term outcome of such transfers for irreparable posterosuperior rotator cuff tears to determine the durability of the results and to identify risk factors for an unfavorable outcome. Methods: Fifty-seven shoulders in fifty-five patients (seventeen women and thirty-eight men with a mean age of fifty-six years) were managed with latissimus dorsi tendon transfer. Final follow-up was performed at a mean of 147 months. Outcome measures included the Constant score and the Subjective Shoulder Value (SSV). Osteoarthritis, the acromiohumeral distance, and the so-called critical shoulder angle were assessed on standardized radiographs. Results: Forty-six shoulders in forty-four patients were available at the time of final follow-up. The mean SSV increased from 29% preoperatively to 70% at the time of final follow-up, the relative Constant score improved from 56% to 80%, and the pain score improved from 7 to 13 points (p < 0.0001 for all). Mean flexion increased from 118° to 132°, abduction increased from 112° to 123°, and external rotation increased from 18° to 33°. Mean abduction strength increased from 1.2 to 2.0 kg (p = 0.001). There was a slight but significant increase in osteoarthritic changes. Inferior results occurred in shoulders with insufficiency of the subscapularis muscle and fatty infiltration of the teres minor muscle. Superior functional results were observed in shoulders with a small postoperative critical shoulder angle. Conclusions: Latissimus dorsi tendon transfer offered an effective treatment for irreparable posterosuperior rotator cuff tears, with substantial and durable improvements in shoulder function and pain relief. Shoulders with fatty infiltration of the teres minor muscle and insufficiency of the subscapularis muscle tended to have inferior results, as did those with a large critical shoulder angle. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.