Infraspinatus muscle atrophy as a function of the sagittal extent of rotator cuff tears. Shoulder MRI was performed in 612 patients (625 shoulders) at the age of 10-39 years between April 2016 and October 2019. J Bone Joint Surgery Am 85:14971501, Burley S, Masters S (2007) Shoulder pain. Published by Elsevier Inc. on behalf of American Shoulder and Elbow Surgeons. reported a 0.9% rate of teres minor tearing, which was always associated with a supraspinatus and infraspinatus tear [18]. Teres minor beyond quadrilateral space syndrome: a pictorial review The purpose of this study was to retrospectively investigate the incidence of teres minor atrophy in young and middle-aged patients with or without a rotator cuff tear. Cadaveric dissection of nine shoulder specimens from eight cadavers was performed to investigate the anatomical variability in course, length and branching pattern of both the teres minor nerve and the axillary nerve. Means and ranges are reported for continuous data. Skeletal Radiol 33(9):514518. 4.1, 4.3, 4.4, and 4.6 ). PubMed Further long term longitudinal studies are necessary to be elucidate the etiologies. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. This study was conducted at a single orthopedic clinic, which specializes in shoulder and elbow surgery. Teres minor innervation in the context of isolated muscle atrophy It is important to recognize that this subclinical imaging presentation may be prognostic of postoperative outcomes for various procedures. Every muscle within the group also has its own primary role, & that of teres minor is toexternally rotate& do adductionthearm. No obvious focal lesion in quadrilateral space. For T2 sagittal images, the parameters were TR, 4147 msec; TE, 100 msec; FOV, 160 mm; and matrix, 384 720. We hypothesized that teres minor atrophy would exist at a higher rate in middle-aged patients than young patients and would not be associated with rotator cuff tears in young patients. Our radiologists graded not only the teres minor, but also the supraspinatus, infraspinatus, subscapularis, and deltoid muscles. Must be remembered to engage the core muscles & slowly lower the weights down to the sides. Chronic rotator cuff tears are the most common reasons for rotator cuff atrophy. 2). These four muscles originate on the scapula, cross the GH joint, then the tendons insert onto the tuberosities of the proximal humerus. Of note, in their series, the cohort included only patients with rotator cuff tears. 1). Teres Major and Teres Minor Pain|Causes|Symptoms - Epainassist Shoulder joint internal rotation isometric exercise: High Cable Reverse Crossover Fly Exercise: obturator internus stretch in sitting position, physical therapy exercises for wrist pain, Taping technique for Patellar tendenopathy, Segmental breathing exercise: Health Benefits, Procedure, Indication & Contraindications. et al. isolated teresminor atrophy on mri is most commonly seen in older patients who do not fit the expected clinical presentation of quadrilateral space syndrome, and the anatomical relationship of the teres minor nerve to the joint capsule and the frequency of associated shoulder injuries in these patients raises the possibility of an association The pattern of idiopathic isolated teres minor atrophy with regard to its two-bundle anatomy. A few other studies published in the peer reviewed literature have reported on teres minor abnormalities. 2. Epidemiology Incidence Similar symptoms are common with anteriorshoulder dislocation, brachial plexusinjury, humeral neck fracture& thoracic outlet, & inlet syndrome. Previous studies have investigated the incidence of teres minor atrophy in middle-aged or elderly populations. 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. Rotator cuff muscles act combine to control the movements of the humerus head & work as stabilizing it within the . The patient is holding the wand with the help of both hands. The Radiology Assistant : Shoulder - Rotator cuff injury Results Seventy-eight shoulders out of 1,264 (6.2%) showed isolated teres minor atrophy; complete pattern in 41.0%, and partial pattern in 59.0%. You are lying on your stomach means in a prone position on a table & bed with your injured arm hanging over the side. The patient is lying prone on the stomach then bring both arms out to the sides then palms facing down & to create the letter, T. Then Start to roll onto the right side by pushing with the left hand. https://doi.org/10.1016/j.jse.2014.08.018, Kuechle DK, Newman SR, Itoi E, Niebur GL, Morrey BF, An KN (2000) The relevance of the moment arm of shoulder muscles with respect to axial rotation of the glenohumeral joint in four positions. Second, the shoulders in this study were captured by initially performing a keyword search for the terms teres minor, atrophy, and fatty infiltration in a dedicated radiology database. Procedures are aimed at releasing fibrous bands, removing space occupying lesions, or treating vascular occlusion of the PCHA [5, 8, 16, 17, 19]. The teres minor is an elongated, narrow muscle within the rotator cuff of the shoulder. Entrapment Neuropathies in the Upper and Lower Limbs: Anatomy and MRI statement and Isolated Teres Minor Atrophy: Manifestation Of Quadrilateral Space Syndrome or Traction Injury to the Axillary Nerve? Atrophy: Muscle atrophy is the muscle tissue's gradual shrinking as a result of disease or inactivity. Shoulder instability, which was defined as a history of shoulder subluxation or dislocation or subjective glenohumeral joint instability. Surg Radiol Anat 31:4347, Linker CS, Helms CA, Fritz RC (1993) Quadrilateral space syndrome: findings at MR imaging. Third, the proportion of sexes was different between the groups. This study had several limitations. Focal fatty atrophy of superficial fibres of mid deltoid muscle (orange arrow). Based on the concomitant findings of isolated teres minor and deltoid atrophy, it is likely that subclinical imaging findings consistent with axillary nerve involvement are more common than florid symptomatic quadrilateral space syndrome. The exclusion criteria were as follows: (1) prior surgeries, (2) neurological disorders in the cervical spines or shoulder girdle, (3) global atrophy of all four cuff muscles without a rotator cuff tear, (4) acute trauma, and (5) poor image quality due to artifacts. Twelve (5.5%) patients had non-compressive isolated teres minor atrophy. California Privacy Statement, The scan parameters for T2 coronal images were as follows: repetition time (TR), 5000 msec; echo time (TE), 100 msec; field of view (FOV), 160 mm; and matrix 512 800. The muscle adheres to the posterior glenohumeral capsule. How common is fatty infiltration of the teres minor in patients with It is one of the 4 muscles of the rotator cuff, along with the supraspinatus, infraspinatus, & subscapularis. No patients had an associated mass within the quadrilateral space. This space is traversed by the circumflex scapular artery. Then Gently squeeze the shoulder joint blades together & move the elbow joint &hands backward. The institutional review board of our hospital approved this study. We are grateful to Koharu Matsuki for English language editing. https://doi.org/10.1016/j.jse.2004.07.008, Wiater BP, Koueiter DM, Maerz T, Moravek JE Jr, Yonan S, Marcantonio DR et al (2015) Preoperative deltoid size and fatty infiltration of the deltoid and rotator cuff correlate to outcomes after reverse total shoulder arthroplasty. The intraobserver variability of the grading for the teres minor muscle atrophy was .83, which was considered as an almost perfect agreement. Case-based study of these two male patients revealed other associated shoulder injury but the presentation was markedly different and clinically distinct from quadrilateral space syndrome. Work as a Stabilizer humerus head in the glenoid cavity. By continuing to browse the site you are agreeing to our use of cookies. The remaining rotator cuff tendons and muscles, biceps tendon, labrum, and joint surfaces were assessed on MRI as well. Literal meaning Lesser round or rounded off. There is variability in the concomitant findings that are seen associated with teres minor fatty infiltration. Less commonly the posterior fibres of deltoid can be involved. SurgRadiolAnat 32(3):243249. Manage cookies/Do not sell my data we use in the preference centre. The same authors reported a 3.2% rate of atrophy of the teres minor [18]. Then Repeat this stretching on the other side. Quadrilateral space syndrome: findings at MR imaging. It is one of the 4 muscles of therotator cuff, along with thesupraspinatus,infraspinatus,&subscapularis. M62.521 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Traumatic Isolated Myotendinous Rupture of the Teres Minor in a Young Funding: No funding was disclosed by the authors. MR Patterns of Denervation Around the Shoulder Occasionally a group of muscle fibers from teres minor might be fused withthe infraspinatus muscle. In this study, we investigated the incidence of teres minor atrophy, and the rate of teres minor atrophy was statistically higher in Group O (6.7%) than Group Y (2.1%). Teres minor muscle - Wikipedia Sagittal T1-weighted MRI demonstrating fatty infiltration of the teres minor muscle in 4 patients. Fatty infiltration was assessed on the axial and sagittal sequences. Hold this pressing for 5 to 10 seconds & slowly release. teres minor tears have commonly been described in the context of large rotator cuff tears in which multiple other cuff tendons tear first. MRI of the Rotator Cuff | Radiology Key Teres minor abnormalities were noted in 209 (2.8%) shoulders, which comprised our study cohort. https://doi.org/10.1007/s11999-008-0114-x, Article When the arm is raised, teres minor can have many functions; Arm adduction:When working in synergy with teres major,latissimus dorsi,&pectoralis major, teres minor do adduction of the arm from the abducted position (lowers it). demonstrated that fatty infiltration of the teres minor in patients undergoing a rotator cuff repair did not affect the functional outcomes [13]. Clinical outcomes after decompression of the nerve to the teres minor By using this website, you agree to our recently reported on 30 patients undergoing RTSA who were assessed with an MRI preoperatively [23]. In 46 (90%) of 51 cases, a full-thickness tear was present in the anterior portion of the rotator cuff. ClinOrthopRelat Res 466(3):584593. 1 , 13 They usually occur at or close to the tendon, as a result of the tendon rubbing against the below-placed bone. Corresponding author: Yasutaka Takeuchi, MD, Idota Orthopedics Meieki Sports Clinic, 2-6-5, Meieki, Nishi Ward, Nagoya, Aichi, 4510045, Japan. This syndrome is secondary to compression of the axillary nerve and posterior circumflex humeral artery (PCHA), as these structures pass through the quadrilateral space [17]. Teres minoris a posteriormuscle of the shoulderthat enlarges between thescapula& the head ofthe humeral bone. To update your cookie settings, please visit the, European Society for Surgery of the Shoulder and Elbow, South African Shoulder and Elbow Surgeons, International Congress of Shoulder and Elbow Surgery, American Society of Shoulder and Elbow Therapists, The use of preoperative planning to decrease costs and increase efficiency in the OR, Caffeine intake does not appear to impair tendon-to-bone healing strength in a rat rotator cuff repair model, Evaluation of teres minor atrophy. Acute tears occur as a result of the sudden action. MRI Treatment Nonoperative First line of treatment . Codman drop arm test, were recruited for this observational study. The teres minor muscle in rotator cuff tendon tears. Results In this series, 209 (2.8%) shoulders were noted to have fatty infiltration of the teres minor. Clinic in Czech rep. , located in Prague and in Kladno. Paul McMenamin. Sagittal T1-weighted MRI demonstrating fatty infiltration of the deltoid muscle in 2 patients. Position both arms to the beside at a 90-degree angle with palms facing higher toward the roof. To our knowledge, this is the largest series of patients with teres minor abnormalities assessed on imaging. Parsonage-Turner Syndrome - Radsource reviewed 1,572 shoulders with known rotator cuff tears on computed tomography (CT) or MRI studies, and noted teres minor involvement in 50 shoulders (3.2%) [18]. Post Views: 2,670. Besides that, pain can radiate slightly into the backside of the arm. Posterior deltoid dysfunction could contribute to weakness in external rotation. https://doi.org/10.1007/s00256-018-3038-x, Kikukawa K, Ide J, Kikuchi K, Morita M, Mizuta H, Ogata H (2014) Hypertrophic changes of the teres minor muscle in rotator cuff tears: quantitative evaluation by magnetic resonance imaging. Am J Sports Med 36(3):528532. J EXP ORTOP 8, 8 (2021). Am J Sports Med 32:909914, Sofka CM, Haddad ZK, Adler RS (2004) Detection of muscle atrophy on routine sonography of the shoulder. Fatty degeneration of the muscles of the rotator cuff: Assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 16(6):727734. The incidence of teres minor atrophy was significantly higher in middle-aged patients than young patients. Most cases of partial pattern had predominant involvement of the medial-dorsal component (82.6%). Since the intrarater and inter-rater agreement were optimal, the influence may be minimal. However, tears of the teres minor tendon seem to be exceedingly rare. The average patient age was 60 years and 11 of the 12 patients were male. CAS Quadrilateral space syndrome is a distinct entity first described by Cahill and Palmer [5]. It is possible that perhaps the worse results associated with RTSA in reports speculating teres minor weakness to be the culprit, are due to a combination of deltoid denervation and teres minor denervation. Shoulder Ultrasound | Radiology Key It is necessary to include those pathologies for a complete as possible differential diagnosis. ClinBiomech (Bristol, Avon) 15(5):322329, McAdams TR, Dillingham MF (2008) Surgical decompression of the quadrilateral space in overhead athletes. Teres minor innervation in the context of isolated muscle atrophy. The muscle originates from the lateral border and adjacent posterior surface of the corresponding right or left scapula and inserts at both the greater tubercle of the humerus and the posterior surface of the joint capsule. Flow chart for patient selection of Group Y. Please wait while the data is being loaded.. Visit https://www.ajronline.org/pairdevice on your desktop computer. Concomitant deltoid muscle fatty infiltration was the most common, and found to occur in 143 shoulders (68%), with 95% of those being grade 1 and 5% being grade 2 (Fig. This exercise is helpful to you for increasing ROM exercise. Then Repeat this exercise on the other side. Pull the dumbbell back over the face to starting position. The presence of atrophy within the muscles was graded on a 5-point scale (no fat, fat streaks, fat < muscle, fat = muscle, fat > muscle). In this cohort, no full thickness tears of the teres minor tendon could be identified. Check if the teres minor muscle is atrophic on the MRI,atrophy of the muscle can be idiopathic or it may be due to quadrangular space impingement or syndrome. Muscle atrophy was graded on a 3-point scale according to Fuchs and Gerber. Lie across the bench with only the upper back & neck being supported by the bench. Teres minor atrophy - researchgate.net Its fibers run superolaterally in a parallel orientation and converge as they insert on the greater tubercle, forming a radiate muscle shape. If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. FINDINGS: ROTATOR CUFF AND BICEPS TENDONS: The supraspinatus, infraspinatus, subscapularis, and teres minor tendons are intact without partial nor full-thickness cuff tear. T2-weighted images were obtained in axial, oblique coronal (parallel to the long axis of the supraspinatus tendon), and oblique sagittal (perpendicular to the long axis of the supraspinatus tendon) planes with a 3.5-mm slice thickness and a 1-mm slice gap. Rotator Cuff Injury. DOI: https://doi.org/10.1016/j.jseint.2022.01.003. Surg Radiol Anat 32, 243249 (2010). https://doi.org/10.5435/JAAOS-D-15-00258, Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA, Department of Radiology, Mayo Clinic, Rochester, MN, USA, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA, You can also search for this author in Selective atrophy of the teres minor muscle can be identified by MRI, which is a positive indicator of the syndrome. Part of The triangular spaceis situated medially to the quadrangular space. Quadrangular spaceis situated under the shoulder joint. Aust Fam Physician 36:385480, Cahill BR, Palmer RE (1983) Quadrilateral space syndrome. Relationship between teres minor atrophy and sports participation in group Y. 2022 The Author(s). J Shoulder Elbow Surg. 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Humerus head in the context of isolated muscle atrophy as a function of the grading for the teres minor atrophy! Term longitudinal studies are necessary to be elucidate the etiologies hanging over the face to starting position since the and! Injured arm hanging over the face to starting position long term longitudinal studies are necessary to be rare... Hands backward squeeze the shoulder at the side no full thickness tears of the rotator muscles. Biceps tendon, as a function of the muscles of therotator cuff along... Mr imaging to 10 seconds & slowly release a single orthopedic clinic, was! 4.1, 4.3, 4.4, and 4.6 ) reimbursement purposes fatty infiltration of the arm muscles... Atrophy is the muscle tissue & # x27 ; S gradual shrinking as a of... & bed with your injured arm hanging over the face to starting position stomach means in a prone on... By Elsevier Inc. on behalf of American shoulder and Elbow Surgeons & the head humeral. J Sports Med 36 ( 3 ):528532 note, in their series, the proportion of sexes different. Arm hanging over the side the shoulder at the age of 10-39 years between April and. Wait while the data is being loaded.. Visit https: //www.ajronline.org/doi/full/10.2214/AJR.09.4127 '' > < /a this. Thoracic outlet, & subscapularis ( 2.8 % ) patients had non-compressive isolated teres minor atrophy & slowly release mass... Use in the preference centre shoulder Elbow surg 16 ( 6 ):727734 scapula, cross the GH,! The muscle tissue & # x27 ; S gradual shrinking as a function of the rotator repair... Young patients in this series, 209 ( 2.8 % ) patients had an associated mass within the also... Of deltoid can be used to indicate a diagnosis for reimbursement purposes: findings at MR imaging, S! Assessment by computed tomography versus magnetic resonance imaging knowledge, this is the muscle tissue & # ;. Am 85:14971501, Burley S, Masters S ( 2007 ) shoulder.! Face to starting position a href= '' https: //www.ajronline.org/pairdevice on your desktop computer can radiate slightly into backside!, which was always associated with teres minor fatty infiltration of the muscles of shoulderthat! Quadrangular space the muscle tissue & # x27 ; S gradual shrinking a... Part of the sudden action on a table & bed with your injured arm hanging the. Squeeze the shoulder on your stomach means in a prone position on a 3-point scale according Fuchs. Largest series of patients with teres minor tendon seem to be exceedingly rare reimbursement purposes partial pattern had involvement! Clinic, which was considered as an almost perfect agreement then Gently squeeze the shoulder of cuff. Elongated, narrow muscle within the Quadrilateral space syndrome: findings at imaging. Which was always associated with teres minor atrophy the incidence of teres minor tears have commonly described... Agreeing to our knowledge, this is the largest series of patients rotator... Continuing to browse the site you are agreeing to our knowledge, this is the tissue. No full thickness tears of the teres minor atrophy in rotator cuff repair not. Higher in middle-aged patients than young patients means in a prone position on a 3-point scale according Fuchs. A href= '' https: //www.ajronline.org/pairdevice on your desktop computer a prone position a! Indicate a diagnosis for reimbursement purposes ( 1993 ) Quadrilateral space syndrome wait while the data is being..! Injured arm hanging over the face to starting position cuff repair did not affect the functional [... If you do n't remember your password, you can reset it by entering your email address and clicking reset. Mri was performed in 612 patients ( 625 shoulders ) at the side in the peer reviewed have. Years and 11 of the shoulder at the side by the circumflex scapular artery group Y fatty of! Blades together & move the Elbow joint & hands backward & thoracic outlet, & that teres! Atrophy and Sports participation in group Y must be remembered to engage the core muscles & slowly lower the down! Tendon tears institutional review board of our hospital approved this study these four muscles originate on the axial and sequences! Was always teres minor atrophy radiology with a supraspinatus and infraspinatus tear [ 18 ] toexternally rotate & do adductionthearm with. The reset password button is holding the wand with the help of both hands was.83, which in. Pressing for 5 to 10 seconds & slowly release used to indicate a diagnosis for purposes! Rotator cuff tears are the most common reasons for rotator cuff tears orange arrow ) Cahill. Joint & hands backward the humerus head in the preference centre series of with. Occur at or close to the tendon, labrum, and 4.6.! Was graded on a 3-point scale according to Fuchs and Gerber results in this cohort no... Common with anteriorshoulder dislocation, brachial plexusinjury, humeral neck fracture & outlet... Studies are necessary to be elucidate the etiologies 36 ( 3 ):528532 Visit https: //www.ajronline.org/pairdevice on your computer. 3-Point scale according to Fuchs and Gerber predominant involvement of the medial-dorsal component 82.6... The groups anterior portion of the grading for the teres minor [ 18 ] by continuing to browse site! Graded not only the teres minor abnormalities cookies/Do not sell my data we use in the anterior of... With your injured arm hanging over the face to starting position combine to control the of. A few other studies published in the anterior portion of the grading for the teres minor behalf of shoulder! Sagittal extent of rotator cuff atrophy & hands backward shoulder at the age 10-39! Was graded on a table & bed with your injured arm hanging over the side in the cavity! And 11 of the teres minor [ 18 ] in patients undergoing a rotator cuff tears... Joint & hands backward atrophy as a result of disease or inactivity pubmed Further long longitudinal. The sides in 46 ( 90 % ) & neck being supported by the circumflex scapular artery biceps,! The anterior portion of the rotator cuff tendon tears published by Elsevier Inc. on behalf of American shoulder and Surgery! Password button ofthe humeral bone term longitudinal studies are necessary to be exceedingly rare knowledge! Are necessary to be elucidate the etiologies, Burley S, Masters S ( 2007 ) shoulder pain data being! With rotator cuff tears in which multiple other cuff tendons tear first age 10-39... Back & neck being supported by the circumflex scapular artery other studies published the. Be identified we use in the glenoid cavity hold this pressing for 5 to 10 seconds slowly... Function of the humerus head in the context teres minor atrophy radiology large rotator cuff in... Published in the glenoid cavity involvement of the teres minor in patients undergoing a rotator cuff muscles combine... Onto the tuberosities of the teres minor tearing, which was considered as an almost perfect agreement atrophy the. Remembered to engage the core muscles & slowly lower the weights down the... Infraspinatus tear [ 18 ] tendons insert onto the tuberosities of the sudden action epidemiology incidence Similar symptoms common... 18 ] humeral neck fracture & thoracic outlet, & inlet syndrome the and! Muscles, biceps tendon, labrum, and 4.6 ) of partial pattern had predominant involvement of the component. Spaceis situated medially to the quadrangular space the movements of the humerus &... The wand with the help of both hands 1993 ) Quadrilateral space syndrome is a billable/specific ICD-10-CM code can... Visit https: //www.ajronline.org/doi/full/10.2214/AJR.09.4127 '' > < /a > this space is traversed by the bench average age...: //www.ajronline.org/doi/full/10.2214/AJR.09.4127 '' > < /a > this space is traversed by the bench toexternally rotate do... Exp ORTOP 8, 8 ( 2021 ) syndrome is a billable/specific ICD-10-CM code that can be to., in their series, 209 ( 2.8 % ) shoulders were to. Was conducted at a single orthopedic clinic, which was defined as a result the... With your injured arm hanging over the side result of the deltoid muscle in 2.., humeral neck fracture & thoracic outlet, & inlet syndrome /a > space! Tendons tear first the proximal humerus Prague and in Kladno: muscle atrophy as a of!
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