Studies have shown that the trees minor plays an important role after total (TSA) and reverse (RSA) shoulder arthroplasty, as well as in maintenance of function in the setting of infraspinatus wasting. In this regard, teres minor hypertrophy has been described as a compensatory change in response to this infraspinatus wasting, and has been suggested that this compensatory hypertrophy may mitigate the loss of infraspinatus function in the patient with a large rotator cuff tear. The purpose of this study was to determine the prevalence of teres minor hypertrophy in a cohort of patients undergoing rotator cuff repair, and to determine its prognostic effect, if any, on outcomes after surgical repair. Over a 3 year period, all rotator cuff repairs performed in a single practice by 3 ASES member surgeons were collected. Inclusion criteria included both preoperative and postoperative validated outcomes measures (minimum 2 year), and preoperative Magnetic Resonance Imaging (MRI) scanning. 144 patients met all criteria. MRIs were evaluated for rotator cuff tear tendon involvement, tear size, and Goutallier changes of each muscle. In addition, occupational ratios were determined for the supraspinatus, infraspinatus, and teres minor muscles. Patients were divided into 2 groups, based upon whether they had teres minor hypertrophy or not, based on a previously established definition. A 2 way ANOVA was used to determine the effect of teres minor hypertrophy(tear size by hypertrophy) and Goutallier Teres minor hypertrophy was a relatively common finding in this cohort of rotator cuff patients, with 51% of all shoulders demonstrating hypertrophy. Interestingly, in patients without an infraspinatus tear, teres minor hypertrophy was still present in 19/40 (48%) of patients. Teres minor hypertrophy had a significant, negative effect ASES scores after rotator cuff repair in patients with and without infraspinatus tearing, infraspinatus atrophy, and fatty infiltrative changes (P<0.05). In general, the presence of teres minor hypertrophy showed 10–15% less improvement (Figure 1) than when no hypertrophy was present, and this was consistent across all tear sizes, independent of Goutallier changes. Teres minor hypertrophy is a common finding in the setting of rotator cuff tearing, including in the absence of infraspinatus tearing. Contrary to previous publications, the presence of teres minor hypertrophy in patients with rotator cuff repair does not appear to be protective as a compensatory mechanism. While further study is necessary to determine the mechanism or implication of teres minor hypertrophy in setting of rotator cuff repair, our results show it is not a positive of outcomes following rotator cuff repair.
To provide a comprehensive radiographic, clinical, and functional description of the shoulder in Apert Syndrome. A cohort of nine Apert Syndrome patients (ages nine to twenty-seven) followed at a tertiary care facility was included in this prospective study. Patients were clinically assessed with physical examination and completion of two validated functional assessment tools, the Shoulder Pain and Disability Index (SPADI) and AAOS Paediatrics Questionnaire (PODCI). Radiographs were obtained of both shoulders and a standardised protocol MRI was performed on the dominant shoulder of all participants. All patients had some degree of functional impairment attributable to their shoulder pathology. Physical examination consistently revealed reduced forward flex-ion and abduction. Radiographic findings were similar to previous reports, with pervasive osseous dysplasia of the shoulder joint. Medial humeral head hypoplasia was seen in eight out of nine patients and greater tuberosity overgrowth in seven out of nine patients. MR imaging of the shoulder, not previously performed in a cohort of Apert patients, allowed better delineation of abnormalities seen radiographically such as a central glenoid cleft, seen in eight out of nine patients. It also revealed a new finding of inferior glenoid inclination (seven out of nine patients), which has not been described in the literature. Very few soft tissue or degenerative abnormalities were demonstrated. The findings of this study confirm that patients with Apert Syndrome are functionally impaired by their shoulder pathology, which may have a similar clinical impact as the more well-described hand and foot anomalies. The global functioning of patients with Apert syndrome is equivalent to patients with juvenile rheumatoid arthritis. The shoulder range of motion in Apert patients is decreased, most significantly in flexion and abduction. Radiographs confirmed previous imaging findings of glenohumeral dysplasia. The novel MRI component demonstrated consistent inferior glenoid inclination, which may be a significant factor in their shoulder impairment. MR imaging revealed no significant soft tissue or degenerative abnormalities to account for their clinical disability. These findings have potential relevance in the surgical and clinical management of these patients.
The stability of an external ring fixator using trans-osseous wires is determined by the number of wires per ring, their tension and their configuration. Ideally a crossing angle of 90° in the centre of the bone provides the greatest stability. This is however rarely possible due to the restrictions imposed by safe anatomical corridors. The Taylor Spatial Frame is a hexapod structure which relies on 6 connecting struts attached to fixed tabs on the ring; the Ilizarov system allows connecting rods to be placed in any available spaces. The aim of this study was to identify differences in wire placement using the TSF compared with the standard Ilizarov ring.
