scholarly journals How common is fatty infiltration of the teres minor in patients with shoulder pain? A review of 7,367 consecutive MRI scans

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
William R. Aibinder ◽  
Derrick A. Doolittle ◽  
Doris E. Wenger ◽  
Joaquin Sanchez-Sotelo
Keyword(s):  
Rotator Cuff ◽  
Shoulder Pain ◽  
Muscle Atrophy ◽  
External Rotation ◽  
Reverse Shoulder Arthroplasty ◽  
Fatty Infiltration ◽  
Deltoid Muscle ◽  
Rotator Cuff Tears ◽  
Shoulder Mri ◽  
Teres Minor

Abstract Purpose The teres minor is particularly important for activities that require external rotation in abduction in the settings of both rotator cuff tears and reverse shoulder arthroplasty. This study sought to assess the incidence of teres minor fatty infiltration in a large cohort of consecutive patients evaluated with shoulder MRI for shoulder pain and to identify all associated pathologies in an effort to determine the various potential etiologies of teres minor involvement. Methods A retrospective review of 7,376 non-contrast shoulder MRI studies performed between 2010 and 2015 were specifically evaluated for teres minor fatty infiltration. Studies were reviewed by two fellowship trained musculoskeletal radiologists. Muscle atrophy was graded on a 3-point scale according to Fuchs and Gerber. The remaining rotator cuff tendons and muscles, biceps tendon, labrum, and joint surfaces were assessed on MRI as well. Results In this series, 209 (2.8%) shoulders were noted to have fatty infiltration of the teres minor. The rate of isolated fatty infiltration of the teres minor was 0.4%. Concomitant deltoid muscle atrophy was common, and occurred in 68% of the shoulders with fatty infiltration of the teres minor. Tearing of the teres minor tendon was extremely rare. Conclusion Fatty infiltration of the teres minor can occur in isolation, be associated with deltoid muscle atrophy only, or occur in the setting of rotator cuff full tears. Thus, fatty infiltration of the teres minor may be related to a neurologic process or disuse. Further long term longitudinal studies are necessary to be elucidate the etiologies. Level of Evidence Level IV.

MRI quantification of fatty infiltration and muscle atrophy in a mouse model of rotator cuff tears

2012 ◽  
Vol 31 (3) ◽  
pp. 421-426 ◽  
Author(s):  
Sanjum P. Samagh ◽  
Erik J. Kramer ◽  
Gerd Melkus ◽  
Dominique Laron ◽  
Blake M. Bodendorfer ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Mouse Model ◽  
Muscle Atrophy ◽  
Fatty Infiltration ◽  
Rotator Cuff Tears

scholarly journals Effect of Muscle Quality on Operative and Nonoperative Treatment of Rotator Cuff Tears

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986301
Author(s):  
Micah Naimark ◽  
Thai Trinh ◽  
Christopher Robbins ◽  
Bridger Rodoni ◽  
James Carpenter ◽  
...  
Keyword(s):  
Cohort Study ◽  
Rotator Cuff ◽  
Muscle Atrophy ◽  
Fatty Infiltration ◽  
Nonoperative Treatment ◽  
Nonsurgical Treatment ◽  
Muscle Quality ◽  
Rotator Cuff Tears ◽  
The Impact ◽  
Surgical Group

Background: Rotator cuff muscle atrophy and fatty infiltration are predictors of negative outcomes after rotator cuff repair. However, the impact of muscle degeneration on nonsurgical treatment is unknown. Hypothesis: Rotator cuff muscle atrophy and fatty infiltration will reduce the outcomes of operative repair while having a minimal effect on nonsurgical treatment. Additionally, in the setting of atrophy and fatty infiltration, surgical and nonsurgical treatment will produce equivalent outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing operative and nonoperative treatment of full-thickness rotator cuff tears were prospectively enrolled into a nonrandomized cohort study. Muscle quality was assessed on magnetic resonance imaging by use of the supraspinatus tangent sign, Warner atrophy, and Goutallier fatty infiltration classifications. Grading was performed by 2 independent observers who were blinded to patient treatment and outcomes. Normalized Western Ontario Rotator Cuff (WORC) index was the primary patient-reported outcome. Multivariate linear regression analysis was used to determine the impact of muscle quality on treatment outcomes. Results: The cohort consisted of 157 patients, 89 (57%) surgical and 68 (43%) nonsurgical, with a mean follow-up of 2.4 years (range, 1-5 years). Tangent sign had the best inter- and intrarater reliability, with kappa statistics of 0.81 and 0.86, respectively. Reliability for Warner atrophy was 0.69 to 0.76 and for Goutallier classification was 0.54 to 0.64. Overall, improvement in WORC scores was higher in the surgical group than the nonsurgical group (39.3 vs 21.2; P < .001). A positive tangent sign was the only independent predictor ( P < .01) of worse outcomes in the surgical group, accounting for an estimated 22-point lower improvement in WORC scores. Conclusion: A positive tangent sign was predictive of worse operative outcomes, resulting in equivalent improvements between surgical and nonsurgical treatment. The tangent sign is a reliable, prognostic indicator that clinicians can use when counseling patients on the optimal treatment of rotator cuff tears.

scholarly journals The effect of obesity on fatty infiltration of the rotator cuff musculature in patients without rotator cuff tears

2017 ◽  
Vol 11 (1_suppl) ◽  
pp. 30-38 ◽  
Author(s):  
Andrew P. Matson ◽  
Christopher Kim ◽  
Swara Bajpai ◽  
Cynthia L. Green ◽  
Thomas W. Hash ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Rotator Cuff ◽  
Fatty Infiltration ◽  
Rotator Cuff Tears ◽  
Goutallier Classification ◽  
Mri Scans ◽  
Severely Obese ◽  
Shoulder Mri ◽  
Magnetic Resonance Imaging Mri ◽  
Diagnosis Of Diabetes Mellitus

Background The modified Goutallier classification system describes the fatty infiltration of rotator cuff musculature (RCM) seen on magnetic resonance imaging (MRI) to assist with surgical decision-making for patients with rotator cuff tears (RCT). We describe the relationship between body mass index (BMI) and fatty infiltration in patients without RCT. Methods Twenty-five patients from each of four different BMI ranges (< 25 kg/m2; 25 kg/m2 to 30 kg/m2; 30 kg/m2 to 35 kg/m2; > 35 kg/m2) were randomly selected from 1088 consecutive shoulder MRI scans (T1 parasagittal series). Four physician-readers evaluated MRI scans and assigned modified Goutallier grades (0 to 4) in each of the four rotator cuff muscles, as well as two adjacent muscles. Results Grade distributions varied significantly based on BMI category for infraspinatus ( p = 0.001), teres minor ( p < 0.001), subscapularis ( p = 0.025), teres major ( p < 0.001) and deltoid ( p < 0.001). Higher grades were evident with a diagnosis of diabetes mellitus in three of six muscles ( p < 0.05), hyperlipidaemia in one muscle ( p = 0.021) and greater patient age in three muscles ( p < 0.05). Conclusions Obese and severely obese patients without RCT have more fatty infiltration seen on MRI. Patient factors (older age and diagnosis of diabetes mellitus) can be predictive of fatty infiltration in RCM. Fatty infiltration of RCM is not solely attributable to the presence of a RCT.

Fatty infiltration in the intact supraspinatus tendon; a normal physiological response with increasing age and female gender

2021 ◽  
pp. 175857322110245
Author(s):  
Ailsa Wilson ◽  
Simon BM MacLean
Keyword(s):  
Rotator Cuff ◽  
Muscle Atrophy ◽  
Surgical Repair ◽  
Fatty Infiltration ◽  
Female Gender ◽  
Supraspinatus Tendon ◽  
Rotator Cuff Tears ◽  
Supraspinatus Muscle ◽  
Cuff Tear ◽  
3.0 T

Background Fatty infiltration and muscle atrophy of supraspinatus are used as markers of chronicity in rotator cuff tears and are known to both be independently related to poorer outcomes following surgical repair.1 We hypothesized that supraspinatus muscle atrophy and fatty infiltration increases with age irrespective of whether the rotator cuff is intact and therefore cannot be used as accurate markers for chronicity. Method Retrospective review of 280 patients who underwent 3.0 T shoulder MRI’s with either a normal scan or rotator cuff tear. Two independent observers reviewed the images. Data collected included intact rotator cuff tendons looking specifically at supraspinatus muscle height/length: suprascapular fossa ratio, tangent sign and Goutallier grade for fatty infiltration. Results There were 90 scans with intact rotator cuff tendons. Mean age was 51 years (range 17–86); 52 males, 38 females. On multiple regression analysis, there was a positive correlation of age with fatty infiltration and muscle atrophy on all parameters in the normal intact cuff. Females were significantly more likely than males to have a higher grade of fatty infiltration. Conclusion Age and female gender are risk factors for rotator cuff atrophy and fatty infiltration in patients with normal rotator cuffs. Therefore, these parameters should be used with caution by surgeons when deciding on tear chronicity and the potential to repair the torn rotator cuff.

scholarly journals Primary versus revision arthroscopic bridging reconstruction using dermal allograft: a clinical and radiographic analysis (243)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0035
Author(s):  
Ivan Wong ◽  
Sara Sparavalo ◽  
Jie Ma ◽  
Nedal Alkhatib
Keyword(s):  
Rotator Cuff ◽  
Muscle Atrophy ◽  
Fatty Infiltration ◽  
Rotator Cuff Tears ◽  
Primary Group ◽  
Dash Score ◽  
Massive Rotator Cuff Tears ◽  
Western Ontario Rotator Cuff ◽  
Goutallier Classification

Objectives: Large or massive rotator cuff tears make up between 10-40% of all rotator cuff tears, yet there is no agreement on the best treatment. Previous studies have shown that acellular human dermal allograft (AHDA) can be used for bridging reconstruction with positive patient outcomes. The use of this surgical technique has not been extensively studied in the primary or revision surgical setting. The main objective of this study was to compare the clinical and radiographic outcomes of patients who received primary or revision arthroscopic bridging reconstruction. Methods: This study is a retrospective review of a sequential series of patients who underwent arthroscopic bridging reconstruction (ABR) using AHDA by the primary author (IW). A total of 130 patients underwent ABR between 2010 and 2018. The inclusion criteria were patients with completed Western Ontario Rotator Cuff (WORC) questionnaire, Disabilities of the Arm, Shoulder, and Hand (DASH) score, or both pre-operatively and at multiple post-operative timepoints. Patients with missing WORC scores were excluded from the study. Eighty-three patients were included following chart review. Patients with available post-operative MRIs were also used for radiological assessment by an independent MSK-trained radiologist. Post-operative MRIs were reviewed to assess for graft integrity and changes to rotator cuff muscle atrophy (using the Warner classification) and fatty degeneration (using the Goutallier classification). Results: There were 46 patients who received primary ABR and 37 who received revision ABR. Forty-eight patients had a post-operative MRI available for review (Primary: 25; Revision: 23). The demographics are summarized in Table 1. Both groups showed a significant improvement in WORC score post-operatively (p<0.001). Primary ABR resulted in higher post-operative WORC scores as compared to revision ABR (p=0.015; Figure 1). The incidence of complete re-tears in the primary group was 8% and 17.4% in the revision group. More than 35% of patients in the primary group showed improvement in fatty infiltration of the infraspinatus and supraspinatus muscles. There was a higher progression in muscle atrophy in the revision group as compared to the primary group (74% and 30%, respectively). Conclusions: Arthroscopic primary arthroscopic bridging reconstruction for large/massive rotator cuff tears using acellular human dermal allograft had better improvement in their WORC scores compared to revision group at the final follow-up. Although the revision group had improved at the two-year follow-up, these changes in WORC score were not sustained at the final follow-up while the improvements were maintained for the primary group. The primary group had a smaller re-tear rate, better fatty infiltration and muscle atrophy as compared to the revision group. This suggests that primary bridging reconstruction provides better outcomes than a revision surgery.

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

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712096010
Author(s):  
Erik J. Sarkissian ◽  
Michelle Xiao ◽  
Geoffrey D. Abrams
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Fatty Infiltration ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Level Of Evidence ◽  
Partial Thickness ◽  
Goutallier Classification ◽  
Teres Minor

Background: The teres minor is a critical component of the rotator cuff and serves as one of the few external rotators of the humerus. Information is lacking regarding the effect of teres minor atrophy in isolation and in the setting of concomitant full-thickness rotator cuff tears on outcomes in patients undergoing rotator cuff surgery. Purpose: To investigate the effect of preoperative teres minor fatty infiltration on postoperative clinical outcomes in patients with and without full-thickness rotator cuff pathology. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of patients undergoing primary arthroscopic shoulder surgery between 2014 and 2016 was performed. Preoperative magnetic resonance imaging was used to determine fatty infiltration for each rotator cuff muscle using the modified Goutallier classification. American Shoulder and Elbow Surgeons (ASES) as well as the shortened version of Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were obtained preoperatively and during follow-up. Exclusion criteria included prior surgery on the ipsilateral shoulder or a diagnosis of inflammatory arthropathy. For analysis, patients were dichotomized to grade 0 or grade 1-4 atrophy of the teres minor as well as to full-thickness or partial-thickness rotator cuff pathology. Results: A total of 36 of 47 (76.6%) patients (mean age, 63 years; range, 45-76 years) were available for postoperative follow-up at a mean of 40 months (range, 30-48 months). Postoperative ASES score was significantly higher and QuickDASH score was significantly lower among all patients in the grade 0 group compared with the grade 1-4 group. Postoperative ASES and QuickDASH scores were not significantly different in patients with partial-thickness rotator cuff tears at any time point. However, the postoperative ASES score was significantly higher and QuickDASH score was significantly lower in the grade 0 versus grade 1-4 group for patients with full-thickness rotator cuff pathology. Conclusion: Preoperative teres minor atrophy in patients undergoing surgery for rotator cuff pathology may impair postoperative clinical outcomes, especially in patients with full-thickness tears.

Reverse shoulder arthroplasty for type 1 sequelae of a fracture of the proximal humerus

2018 ◽  
Vol 100-B (3) ◽  
pp. 318-323 ◽  
Author(s):  
P. Raiss ◽  
G. Alami ◽  
T. Bruckner ◽  
P. Magosch ◽  
P. Habermeyer ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Proximal Humerus ◽  
External Rotation ◽  
Constant Score ◽  
Reverse Shoulder Arthroplasty ◽  
Rotator Cuff Tears ◽  
The Mean ◽  
Rotator Cuff Deficiency

Aims The aim of this study was to analyze the results of reverse shoulder arthroplasty (RSA) in patients with type 1 sequelae of a fracture of the proximal humerus in association with rotator cuff deficiency or severe stiffness of the shoulder. Patients and Methods A total of 38 patients were included: 28 women and ten men. Their mean age at the time of arthroplasty was 73 years (54 to 91). Before the RSA, 18 patients had been treated with open reduction and internal fixation following a fracture. A total of 22 patients had a rotator cuff tear and 11 had severe stiffness of the shoulder with < 0° of external rotation. The mean follow-up was 4.3 years (1.5 to 10). The Constant score and the range of movement of the shoulder were recorded preoperatively and at final follow-up. Preoperatively, radiographs in two planes were performed, as well as CT or arthro-CT scans; radiographs were also performed at final follow-up. Results The mean Constant score improved from 25 points (5 to 47) preoperatively to 57 points (15 to 81) postoperatively. The mean forward elevation of the shoulder increased from 73° (10° to 130°) preoperatively to 117° (15° to 170°) postoperatively. Previous surgery did not influence the outcome. Patients with rotator cuff tears had lower Constant scores than patients without (p = 0.037). Those with preoperative stiffness of the shoulder had lower postoperative external rotation compared with patients without stiffness (p = 0.046). There was no radiographic evidence of loosening. Three complications occurred, leading to revision surgery in two patients. In all, 17 patients rated their result as very good (45%), another 17 as good (45%), two as satisfactory (5%), and two as unsatisfactory (5%). Discussion RSA is an effective form of treatment for patients with type 1 sequelae of a fracture of the proximal humerus associated with rotator cuff deficiency or stiffness of the shoulder, with high rates of satisfaction. Rotator cuff tears and stiffness of the shoulder had an adverse effect on the clinical outcome. Cite this article: Bone Joint J 2018;100-B:318–23.

Muscle atrophy and fatty infiltration in rotator cuff tears: Can surgery stop muscular degenerative changes?

2016 ◽  
Vol 21 (5) ◽  
pp. 614-618 ◽  
Author(s):  
M. Fabbri ◽  
A. Ciompi ◽  
R.M. Lanzetti ◽  
A. Vadalà ◽  
D. Lupariello ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Muscle Atrophy ◽  
Fatty Infiltration ◽  
Degenerative Changes ◽  
Rotator Cuff Tears

scholarly journals Factors Related to Preoperative Shoulder Pain in Patients with Atraumatic Painful Rotator Cuff Tears

2019 ◽  
Vol 22 (3) ◽  
pp. 128-134 ◽  
Author(s):  
In Park ◽  
Hyo-Jin Lee ◽  
Sang-Ki Kim ◽  
Min-Sik Park ◽  
Yang-Soo Kim
Keyword(s):  
Diabetes Mellitus ◽  
Rotator Cuff ◽  
Range Of Motion ◽  
Shoulder Pain ◽  
Muscle Atrophy ◽  
Rotator Cuff Tears ◽  
Trauma History ◽  
Male Sex ◽  
The Relationship ◽  
Tear Size

Background: Patients with rotator cuff tears are usually afflicted with shoulder pain and disability. However, it is unclear which factors are related to shoulder pain in patients with rotator cuff tears. This study was therefore undertaken to determine the factors correlated with shoulder pain in patients with painful rotator cuff tears, but without any history of trauma.Methods: We evaluated a cohort of 745 patients with painful rotator cuff tears having no trauma history, and analyzed the relationship between pain and multiple factors including demographic data, tear characteristics, and passive range of motion. Pain was analyzed with a questionnaire concerning the visual analogue scale (VAS) for pain. Tear characteristics were determined by evaluating tear size, muscle atrophy, number of torn tendons, and presence of arthritis. Multivariate linear regression analysis and chi-squared test were applied to evaluate the relationship between the VAS for pain and variable factors.Results: Shoulder pain was associated with young age (<i>p</i>=0.01), male sex (<i>p</i>=0.01) and the presence of diabetes mellitus (<i>p</i><0.001). Measurements of rotator cuff tear characteristics including tear size (<i>p</i>=0.53), muscle atrophy (<i>p</i>=0.16) and the number of torn tendons (<i>p</i>=0.34) did not correlate with shoulder pain. Symptom duration (<i>p</i>=0.60) and range of motion (<i>p</i>>0.05) also showed no correlation with VAS for pain.Conclusions: Young age, male sex and the presence of diabetes mellitus correlated positively with preoperative shoulder pain in patients with painful rotator cuff tears without a trauma history. Combined treatment of pain management and risk factor correction could be helpful to control preoperative shoulder pain.

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