Evaluation of the lag sign tests for external rotator function of the shoulder

Modified latissimus dorsi and teres major transfer through a single delto-pectoral approach for external rotation deficit of the shoulder: As an isolated procedure or with a reverse arthroplasty

“…34,38,47,48,55 2) On radiographic examination, both the infraspinatus and teres minor muscles must be absent or severely fatty infiltrated (Goutallier stage 3 and 4), contra-indicating a tendon repair. 24,31,53 This procedure can be performed alone in patients with ILER or in combination with a reverse arthroplasty for those who present with CLEER and a compromised glenohumeral joint.…”

“…In the present studies, we have used the procedure in 3 clinical conditions: 1) chronic, massive, posterosuperior rotator cuff tears with absent or fatty infiltrated infraspinatus and teres minor muscles; 2) cuff tear arthropathy with combined loss of active elevation and external rotation; 38,47 and 3) tumor of the proximal humerus with resection of the cuff tendons. In these last two instances, a reverse prosthesis was indicated with the muscle-tendon transfer.…”

“…On clinical examination, the dropping, hornblower, and external rotation lag (ERLS) signs are a hallmark of this weak or absent external rotation. 34,38,47,56 Treatment is problematic. Rehabilitation cannot work, as no other muscle can compensate for those definitively lost cuff muscles.…”

Reverse Shoulder Arthroplasty Combined with a Modified Latissimus Dorsi and Teres Major Tendon Transfer for Shoulder Pseudoparalysis Associated with Dropping Arm

“…The loss of active elevation (known as pseudoparalysis) is generally the result of an irreparable superior cuff rupture associated with osteoarthrosis of the shoulder (ie, cuff tear arthropathy-CTA) [37]. The loss of active external rotation is a rare but disabling condition that results from posterior extension of the rotator cuff tear to the teres minor, as isolated infraspinatus rupture is generally well-tolerated [26,29,36,45]. This loss is related to atrophy and fatty infiltration of the posterior cuff muscles and is reportedly irreversible [16,17].…”

To the editor

“…With interest, I read the biomechanical article on lag signs by Hurschler et al 2 On the basis of on their experimental findings, they concluded that the external rotation lag sign (ERLS) has the power to predict infraspinatus/teres minor deficiency but not supraspinatus deficiency. This is in sharp contrast to our clinical experience and to the conclusions of our clinical study.…”