Hypertrophic teres minor restores shoulder strength and range of external rotation in posterosuperior rotator cuff tears

Kikukawa, Kenshi; Ide, Junji; Terakawa, Yusuke; Takada, Koji; Morita, Makoto; Hashimoto, Kazunobu; Mizuta, Hiroshi

doi:10.1016/j.jse.2016.04.016

Cited by 21 publications

(14 citation statements)

References 15 publications

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“…19 In these studies, progression of infraspinatus atrophy appeared to induce development of compensatory teres minor hypertrophy and subsequently led to greater strength of external rotation in such patients compared with those who had a normal or atrophic teres minor. 20 An understanding of the effect of fatty infiltration on rotator cuff tears may allow clinicians to implement unique shoulder rehabilitation programs to improve functionality in those patients at increased risk for poor postoperative outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The teres minor is a critical component of the rotator cuff and serves as one of the few external rotators of the humerus. 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.…”

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confidence: 99%

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

Sarkissian

Xiao

Abrams

2020

Orthopaedic Journal of Sports Medicine

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Background: The teres minor is a critical component of the rotator cuff and serves as one of the few external rotators of the humerus. Information is lacking regarding the effect of teres minor atrophy in isolation and in the setting of concomitant full-thickness rotator cuff tears on outcomes in patients undergoing rotator cuff surgery. Purpose: To investigate the effect of preoperative teres minor fatty infiltration on postoperative clinical outcomes in patients with and without full-thickness rotator cuff pathology. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of patients undergoing primary arthroscopic shoulder surgery between 2014 and 2016 was performed. Preoperative magnetic resonance imaging was used to determine fatty infiltration for each rotator cuff muscle using the modified Goutallier classification. American Shoulder and Elbow Surgeons (ASES) as well as the shortened version of Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were obtained preoperatively and during follow-up. Exclusion criteria included prior surgery on the ipsilateral shoulder or a diagnosis of inflammatory arthropathy. For analysis, patients were dichotomized to grade 0 or grade 1-4 atrophy of the teres minor as well as to full-thickness or partial-thickness rotator cuff pathology. Results: A total of 36 of 47 (76.6%) patients (mean age, 63 years; range, 45-76 years) were available for postoperative follow-up at a mean of 40 months (range, 30-48 months). Postoperative ASES score was significantly higher and QuickDASH score was significantly lower among all patients in the grade 0 group compared with the grade 1-4 group. Postoperative ASES and QuickDASH scores were not significantly different in patients with partial-thickness rotator cuff tears at any time point. However, the postoperative ASES score was significantly higher and QuickDASH score was significantly lower in the grade 0 versus grade 1-4 group for patients with full-thickness rotator cuff pathology. Conclusion: Preoperative teres minor atrophy in patients undergoing surgery for rotator cuff pathology may impair postoperative clinical outcomes, especially in patients with full-thickness tears.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Sarkissian

Xiao

Abrams

2020

Orthopaedic Journal of Sports Medicine

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“…This may be due to compensation by teres minor muscles. It has been reported that progression of ISP muscle atrophy induces compensatory hypertrophy of the teres minor muscles [27, 28].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with pain in nonsurgically treated rotator cuff tears -A study with magnetic resonance imaging

et al. 2019

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Background In rotator cuff tears, some cases become asymptomatic with nonsurgical treatment, others remain symptomatic. The purpose of this study was to identify factors associated with pain in nonsurgically treated rotator cuff tears using magnetic resonance imaging (MRI). Methods In total, 108 shoulders diagnosed with supraspinatus (SSP) tendon tears using MRI were nonsurgically treated, and MRI was repeated after more than a year. The patients were divided into pain or improvement group according to whether the pain persisted or disappeared. Bursal fluid accumulation; SSP tendon retraction; subscapularis (SSC) tendon tears; infraspinatus (ISP) tendon tears; and Goutallier classification into SSC, SSP, and ISP were included as evaluation factors. Predictive factors for persistent pain on initial MRI and factors associated with persisting pain after nonsurgical treatment on repeat MRI were statistically analyzed using multivariate logistic regression analysis. Results The improvement group showed a significant decrease in bursal fluid accumulation compared with the pain group (p < 0.01). SSC tendon tears (OR, 4.42; 95% CI, 1.16–16.9; P = 0.03) on initial MRI were significantly associated with persistent pain. Bursal fluid accumulation (OR, 2.44; 95% CI, 1.18–5.07; P = 0.02) and SSC tendon tears (OR, 2.25; 95% CI, 1.15–4.39; P = 0.02) on repeat MRI were significantly associated with persistent pain. Conclusions Bursal fluid accumulation decreased when pain improved. The involvement of SSC tendon tears can serve as a predictive factor for persistent pain. Pain may persist although patients with rotator cuff tears including SSC tendon tears are nonsurgically treated. Level of evidence Level IV case-control study

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“…In the light of this pathophysiology [ 35 ], 5 the incomplete recovery of muscle atrophy [ 12 ] and external rotator strength [ 24 , 39 ] indicates that the degeneration of some axons associated with an advanced stage of LTSNN development is irreversible. Furthermore, since the recovery of external rotator strength observed following proper training is also connected with hypertrophy of the teres minor [ 19 , 49 ] the extent of irreversible degeneration of the LTSN axons may be more advanced than first thought.…”

Section: Discussionmentioning

confidence: 99%

A new anatomical insight into the aetiology of lateral trunk of suprascapular nerve neuropathy: isolated infraspinatus atrophy

et al. 2018

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IntroductionAlthough the pathomechanism of isolated infraspinatus atrophy (ISA) in throwing sports is known to be traction, it is unclear why only some players are affected. One likely explanation is that the infraspinatus pulling force exerted by its contracture generate the compressive resultant component force (Fn) compressing the lateral trunk of the suprascapular nerve (LTSN) against the edge of scapular spine. This paper makes two key assumptions (1) the course of LTSN in relation to the scapular spine, defined as the suprascapular-scapular spine angle (SSSA) is the key individual anatomical feature influencing the Fn magnitude, and thus potentially ISA development (2) SSSA is correlated with scapular notch type.Materials and methodsThe bone landmarks of the LTSN course were identified in 18 formalin-fixed cadaveric shoulders, and the SSSA was measured in 101 dry scapulae. The correlation between the SSSA and suprascapular notch type was evaluated. The Fn value was simulated mathematically based on the values of the SSSA of 101 dry scapulae and the prevalence of ISA in chosen throwing sports, as given in the literature: i.e., beach volleyball − 34% (group A1 − 34%; group A2—remaining 66% of scapulae) and tennis − 52% (group B1 − 52%; group B2—remaining 48% of scapulae).ResultsThe mean SSSA value was 44.57° (± 7.9) and Fn 79 N (± 13.1). No statistically significant correlation was revealed between suprascapular notch type and SSSA. Groups A1 and B1 possessed significantly lower SSSA values (p < 0.000) and significantly higher Fn magnitude (p < 0.000) than groups A2 and B2 respectively. The average difference of Fn was 28.1% between group A1 and A2 and 31% between group B1 and B2.ConclusionsThe SSSA has a wide range of values depending on the individual: the angle influencing the magnitude of the compressive resultant force Fn on the LTSN at the lateral edge of the scapular spine via contraction of the infraspinatus muscle. The prevalence of ISA in throwing sports may be correlated with the SSSA of the LTSN. However, further combined clinical, MRI or/and CT studies are needed to confirm this.

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Hypertrophic teres minor restores shoulder strength and range of external rotation in posterosuperior rotator cuff tears

Cited by 21 publications

References 15 publications

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

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

Factors associated with pain in nonsurgically treated rotator cuff tears -A study with magnetic resonance imaging

A new anatomical insight into the aetiology of lateral trunk of suprascapular nerve neuropathy: isolated infraspinatus atrophy

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