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

Sarkissian, E.J.; Xiao, Michelle; Abrams, Geoffrey D.

doi:10.1177/2325967120960107

Cited by 4 publications

(3 citation statements)

References 37 publications

(54 reference statements)

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“…Recent literature has indicated varying patient outcomes with and without teres minor atrophy after rotator cuff repair. In a cohort of 21 patients who underwent repair of full-thickness rotator cuff tears, any degree of preoperative teres minor atrophy (Goutallier grade 1-4) 37 was associated with significantly lower postoperative American Shoulder and Elbow Surgeons (ASES) (48.9 vs. 83.5, p 5 0.0056) and inferior QuickDASH (46.5 vs. 13.1, p 50.0042) scores at a 2year follow-up compared with patients without teres minor atrophy 18 . By contrast, Kim et al 38 evaluated a cohort of 51 patients with preoperative teres minor fatty infiltration of a cohort of 816 patients who underwent rotator cuff repair and demonstrated that fatty infiltration of the teres minor did not affect the visual anolog scale (VAS) (1.5 vs. 1.9, p 5 0.367), Simple Shoulder Test (11 vs. 10, p 5 0.110), ASES (89.1 vs. 87.1, p 50.443), external rotation range of motion (36 vs. 34, p 5 0.744), or strength (5/5 vs. 5/5, p 50.719) at 1 year.…”

Section: Rotator Cuff Pathologymentioning

confidence: 94%

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Teres Minor Muscle Atrophy

2022

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Isolated teres minor atrophy has a reported incidence in the literature of 3% to 6.2%. » There are 2 distinct muscular bundles of the teres minor that have varying degrees of atrophy. Fatty degeneration of the medial-dorsal component exceeds that of the lateral-ventral component in most cases.» A healthy and intact teres minor muscle is of functional importance in the setting of a complete infraspinatus tear because it becomes the only external rotator of the shoulder joint.» Clinical and functional outcomes after rotator cuff repair and reverse shoulder arthroplasty for patients with teres minor atrophy in the setting of a rotator cuff tear are still controversial.

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Section: Rotator Cuff Pathologymentioning

confidence: 94%

“…2). The amount of fatty infiltration and the ability of clinicians to recognize it on imaging are important as it may correlate with improved function after rotator cuff surgery or reverse shoulder replacement [17][18][19] .…”

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confidence: 99%

Teres Minor Muscle Atrophy

2022

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“…Teres minor was for a long time an under-investigated segment of the rotator cuff ( 42 ) until the first long-term outcome study on RSA pointed out its importance ( 18 ). Although its atrophy and fatty infiltration on CT or MR imaging is rare ( 43 ), it has been reported to have an impact on rotator cuff repair and RSA outcomes ( 44 ), as well as outcomes of latissimus dorsi tendon transfers ( 45 ). As shown by Collin, high-grade fatty infiltration of teres minor in massive rotator cuff tears is associated with both AFE pseudoparalysis and ER pseudoparalysis ( 3 ).…”

Section: Pathobiomechanicsmentioning

confidence: 99%

Understanding shoulder pseudoparalysis: Part I: Definition to diagnosis

et al. 2022

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Variable definitions of pseudoparalysis have been used in the literature. Recent systematic reviews and biomechanical studies call for a grading of loss of force couple balance and the use of the terms ‘pseudoparesis’ and ‘pseudoparalysis’. Pain should be excluded as the cause of loss of active function. Key players for loss of force couple balance seem to be the lower subscapularis as an anterior inferior checkrein and the teres minor as a posterior inferior fulcrum. Loss of three out of five muscle–tendon units counting upper and lower subscapularis separately is predictive of pseudoparalysis. Shoulder equator concept: loss of all three posterior, or all three superior, or all three anterior muscle–tendon units is predictive of pseudoparalysis (loss of fulcrum for deltoid force). Every effort should be made to prevent propagation of rotator cuff tears into the subscapularis and posterior rotator cuff (infraspinatus and teres minor) to maintain force couple balance (value of partial cuff repair). Clinical assessment of active forward elevation, active external rotation, and active internal rotation is important to define and grade the severity of loss of force couple balance. Additional features such as patient age, traumatic aetiology, chronicity, fatty infiltration, and stage of cuff tear arthropathy are useful for a specific diagnosis with implications for treatment.

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