Clinical outcomes after decompression of the nerve to the teres minor in patients with idiopathic isolated teres minor fatty atrophy

Abstract

Background The purpose of this manuscript is to describe what we believe to be the first series of patients surgically treated for idiopathic isolated teres minor atrophy and present the results of surgical decompression of the nerve to the teres minor. Methods This is a retrospective cohort of 22 patients who underwent decompression of the nerve to the teres minor for isolated teres minor atrophy. Clinical data including duration of symptoms, additional diagnoses, concurrent procedures, preoperative physical examination, imaging data, and preoperative VAS, SST, and ASES scores were collected from the medical record. Post-operative patient-based clinical outcome measures including VAS, SST and ASES scores were obtained during clinical examination or by telephone interview. Results Average length of follow up was 26 months. Nine patients had concurrent procedures performed. Preoperatively 12/14 (86%) had external rotation weakness in Hornblower’s position. Post-operatively pain scores decreased an average four points; ASES scores increased 31.7±20.2 points; SST scores increased 3.1±2.3 points. No external rotation weakness was noted post-operatively in any tested patient. Two patients developed adhesive capsulitis. No other complications occurred. Conclusions Isolated compression of the nerve to the teres minor compression is a rare and novel clinical entity, and in properly selected cases, open release of the fascial sling enveloping the nerve branches to the teres minor can provide relief of symptoms and clinical improvement.

Preoperative Fatty Infiltration of the Teres Minor Negatively Affects Postoperative Outcomes in Patients With Rotator Cuff Pathology

“…6 A case series showed relief of symptoms and clinical improvement in patients undergoing open decompression of the axillary nerve for isolated teres minor atrophy. 22 The limitations of this study include the retrospective design and inherent biases of a relatively small number of patients. For simplicity, study participants were organized in such a manner as to compare functional outcomes after rotator cuff surgery of patients with absolutely no evidence of teres minor atrophy (Goutallier 0) versus patients with any evidence of teres minor atrophy (Goutallier 1-4).…”

“… 6 A case series showed relief of symptoms and clinical improvement in patients undergoing open decompression of the axillary nerve for isolated teres minor atrophy. 22 …”

“…Although isolated tears of the teres minor can occur, 19 , 20 most tears develop in association with massive rotator cuff pathology and can be associated with teres minor atrophy. 22 Atrophy may also result from either quadrilateral space syndrome 1 , 24 or compression of the primary motor nerve to the teres minor. 3 , 6 Isolated teres minor atrophy without full-thickness rotator cuff pathology has an incidence between 0.8% and 5.5% in persons with shoulder pain.…”

What is the Best Clinical Test for Assessment of the Teres Minor in Massive Rotator Cuff Tears?

“…Our findings are limited to patients with a massive rotator cuff tear without glenohumeral arthritis. However, teres minor insufficiency mostly is seen with massive rotator cuff tears as an isolated lesion of the teres minor (only seen in case of quadrilateral space syndrome, congenital absence, or muscle agenesis) [15,18]. We used CT arthrograms as the comparison to the clinical studies, but there are inaccuracies in the assessment of teres minor tears by CT, and we did not compare the findings with actual tears documented during surgery in these patients.…”

The Neurovascular Structures in the Triangular Space of the Upper Limb: An Anatomical Study

“…Isolated teres minor atrophy is clinically important because the symptom includes posterior shoulder pain, weakness of abducted external rotation (Kruse et al, 2015).…”