Reversed shoulder Arthroplasty with modified L'Episcopo for combined loss of active elevation and external rotation

Boileau, Pascal; Rumian, Adam; Zumstein, Matthias A.

doi:10.1016/j.jse.2009.12.011

Cited by 143 publications

(102 citation statements)

References 35 publications

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“…Boileau et al [2] described three clinical presentations in poorly compensated massive rotator cuff tears: isolated loss of external rotation, isolated pseudoparalysis, and combined loss of active elevation and external rotation. They suggested the latter situation was caused by combined teres minor, infraspinatus and supraspinatus failure [2]-an anatomy equivalent to the classification by Collin et al [4] of massive rotator cuff tear Type E, representing a vertical and horizontal muscular imbalance. However, in the current study, only 33% of patients with Type E tears showed a combined loss of active elevation and external rotation pattern.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, there is biomechanical data that posterior deltoid fibers can impart an external rotation moment on the shoulder in an experimental model [1,16]. Boileau et al [2] and Costouros et al [5] reported on the importance of the teres minor on the outcome after latissimus dorsi transfer or reverse shoulder arthroplasty. Costouros et al [5] reported that functional outcome decreased with an isolated latissimus tendon transfer when teres minor fatty degeneration was greater than Grade 2.…”

Section: Discussionmentioning

confidence: 99%

“…Costouros et al [5] reported that functional outcome decreased with an isolated latissimus tendon transfer when teres minor fatty degeneration was greater than Grade 2. Boileau et al [2] reported on reverse shoulder arthroplasty combined with latissimus tendon transfers for patients with combined loss of active elevation and external rotation. They suggested that patients who are not able to maintain a minimum of neutral rotation with the arm at the side require latissimus tendon transfer in addition to reverse shoulder arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

“…Pseudoparalysis was defined as less than 90°active anterior elevation with maintained passive elevation [26]. Boileau et al [2] described a combined loss of active elevation and external rotation leaving patients unable to control spatial positioning of their upper limb. We considered this phenomenon to correspond to pseudoparalysis and external rotation strength less than 3 (inability to overcome gravity).…”

Section: Study Variables and Clinical Evaluationmentioning

confidence: 99%

See 3 more Smart Citations

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

Treseder

Denard

Neyton

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Few studies define the clinical signs to evaluate the integrity of teres minor in patients with massive rotator cuff tears. CT and MRI, with or without an arthrogram, can be limited by image quality, soft tissue density, motion artifact, and interobserver reliability. Additionally, the ill-defined junction between the infraspinatus and teres minor and the larger muscle-totendon ratio of the teres minor can contribute to error. Therefore, we wished to determine the validity of clinical testing for teres minor tears.Question/Purposes The aim of this study was to determine the accuracy of commonly used clinical signs (external rotation lag sign, drop sign, and the Patte test) for diagnosing the teres minor's integrity. Methods We performed a prospective evaluation of patients referred to our shoulder clinic for massive rotator cuff tears determined by CT arthrograms. The posterosuperior rotator cuff was examined clinically and correlated with CT arthrograms. We assessed interobserver reliability for CT assessment and used three different clinical tests of teres minor function (the external rotation lag sign, dropOne of the authors certifies that he (PC), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount less than USD 10,000 from Storz (Guyancourt, France), and an amount of USD 10,000-USD 100,000 from Tornier (Montbonnot, France). One of the authors certifies that he (GW), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000 from Tornier (Montbonnot, France). One of the authors certifies that he (PJD), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Arthrex (Naples, FL, USA). One of the authors certifies that he (LN), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USA 10,000 to USD 100,000 from Tornier (Montbonnet, France). 123Clin Orthop Relat Res (2015) 473:2959-2966 DOI 10.1007 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® sign, and the Patte test). One hundred patients with a mean age of 68 years were available for the analysis. Results The most accurate test for teres minor dysfunction was an external rotation lag sign greater than 40°, which had a sensitivity of 100% (95% CI, 80%-100%) and a specificity of 92% (95% CI, 84%-96%). External rotation lag signs greater than 10°had a sensitivity of 100% (95% CI, 80%-100%) and a specificity of 51% (95% CI, 40%-61%). The Patte sign had a sensitivity of 93% (95% CI, 70%-99%) and a specificity of 72% (95% CI, 61%-80%). The drop sign had a sensitivity of 87% (95% CI, 62%-96%) and a specificity of 88% (95% CI, 80%-

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Variables and Clinical Evaluationmentioning

confidence: 99%

See 2 more Smart Citations

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

Treseder

Denard

Neyton

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Anatomic studies have highlighted the importance of the infraspinatus as an external rotator, and recent studies have demonstrated the importance of the teres minor in reverse shoulder arthroplasty and latissimus transfers [2,6]. The current paper demonstrates an excellent step forward in improving our knowledge of the external rotators of the shoulder by determining the key physical exam maneuvers to detect a functional teres minor.…”

mentioning

confidence: 83%

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

Feeley

2015

Clinical Orthopaedics &Amp; Related Research

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Effect of reverse shoulder design philosophy on muscle moment arms

Hamilton

Diep

Roche

et al. 2015

Journal Orthopaedic Research

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This study analyzes the muscle moment arms of three different reverse shoulder design philosophies using a previously published method. Digital bone models of the shoulder were imported into a 3D modeling software and markers placed for the origin and insertion of relevant muscles. The anatomic model was used as a baseline for moment arm calculations. Subsequently, three different reverse shoulder designs were virtually implanted and moment arms were analyzed in abduction and external rotation. The results indicate that the lateral offset between the joint center and the axis of the humerus specific to one reverse shoulder design increased the external rotation moment arms of the posterior deltoid relative to the other reverse shoulder designs. The other muscles analyzed demonstrated differences in the moment arms, but none of the differences reached statistical significance. This study demonstrated how the combination of variables making up different reverse shoulder designs can affect the moment arms of the muscles in different and statistically significant ways. The role of humeral offset in reverse shoulder design has not been previously reported and could have an impact on external rotation and stability achieved post-operatively. ß

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Reversed shoulder Arthroplasty with modified L'Episcopo for combined loss of active elevation and external rotation

Cited by 143 publications

References 35 publications

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

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

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

Effect of reverse shoulder design philosophy on muscle moment arms

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