CORR Insights^®: Latissimus Dorsi and Teres Major Transfer With Reverse Shoulder Arthroplasty Restores Active Motion and Reduces Pain for Posterosuperior Cuff Dysfunction

Excerpt

In advanced rotator cuff deficiency, the additional loss of function of the teres minor appears to be the turning point in the natural history of the disease. The absence of the last external shoulder rotator, to counteract the internal rotators, leads to horizontal muscle imbalance with loss of active external rotation control, external rotation lag, and inability to position and hold the hand in space. As opposed to the pseudoparalysis of anterior elevation, which can be corrected, pseudoparalysis of external rotation cannot be restored after reverse total shoulder arthroplasty alone. In 2007, Gerber and colleagues [2] introduced the combination of reverse total shoulder arthroplasty with latissimus dorsi transfer for restoration of elevation and external rotation and presented encouraging early results. This was the combination of two proven concepts, which on their own had withstood the test of time, to address both pseudoparalysis for elevation and external rotation. Now, midterm results of this research group are available, indicating that pain relief and restoration of function is maintained for at least 5 years in most patients [4]. However, depending on patient-specific factors like comorbid conditions, prior surgical procedures, and the surgical technique used, among others, complications (even in the hands of very experienced surgeons) occur in up to 22% [4] to 29% [5] of these procedures. …