Derotational Osteotomies for The Late Treatment of Brachial Plexus Injury

Obstetric brachial plexus palsy [OBBP] can affect the function of the upper extremity. Most of the injuries are limited to the upper spinal nerves and heals spontaneously. However, some of them will have incomplete recovery after OBBP often results in weakness of the external rotators [teres minor and infraspinatus] muscles compared to the internal rotators [teres major, pectoralis major, latissimus dorsi] muscles. The predominance of the internal rotators and adductor muscles over external rotators leads to an internal rotation contracture. The development of internal rotational deformity may progress to increased glenoid retroversion and posterior humeral head subluxation. If the surgeon does not repair internal rotation deformity, the humeral head is forced into a posterior position causing a complete posterior dislocation. Many procedures are performed to treat these deformities: In the young child, improving the remodeling of the glenohumeral joint, capsulectomy, and subscapular release are introduced. Tendon transfers of the shoulder have good results for motion but fail to restore the glenohumeral joint. The failure of improving joint alignment may represent the loss in clinical improvement over time. In older children, a humeral osteotomy can be an alternative to realign the limb into external rotation, improve appearance, and enhance eating, washing hair, and scratching the back of the neck. We will discuss all the techniques along with their advantages and disadvantages.

Effects of Dry Needling in Teres Major Muscle in Elite Handball Athletes. A Randomised Controlled Trial

Objective: To determine the effects of dry needling (DN) in active myofascial trigger points in the teres major muscle compared to an untreated control group in pain during throwing actions, shoulder range of motion (ROM), strength, and extensibility of the tissues in professional handball (HB) athletes. Methods: A randomised, single-blinded, controlled clinical trial was designed. Thirty HB athletes with shoulder pain were randomly assigned to the DN group (n = 15) or control group (n = 15). The DN group received a single session of ultrasound-guided DN technique in the teres major muscle. The control group received no intervention. Pain intensity during throwing actions (Numeric Pain Rating Score), shoulder ROM (inclinometer), isometric strength (hand-held dynamometer), and extensibility (inclinometer) were measured before and after treatment. Results: DN group showed statistically significant improvements with large effect sizes for pain intensity (p < 0.001; E.S: 1.3), internal rotation ROM (p < 0.001; E.S: 3.0) and extensibility (p < 0.001; E.S: 2.9) compared to the control group. No statistically significant differences were found for isometric strength (p > 0.05). Conclusion: A single session of DN in the teres major muscle was effective for improving pain intensity during throwing actions, internal rotation ROM and extensibility in HB athletes with shoulder pain.

Anatomical study of the teres major muscle: description of an additional distal muscle slip

Background Understanding muscle and tendon anatomy is of tremendous importance to achieve optimal surgical execution and results in tendon transfers around the shoulder. The aim of this study was to introduce and describe an additional distal muscle slip of the teres major (TM). Methods Sixteen fresh-frozen cadaver shoulders were dissected with the deltopectoral approach. The ventral latissimus dorsi (LD) tendon was harvested, and the shoulders were analyzed for the presence/absence of a distal teres major slip (dTMs) and its dimensions and relationship with the TM and LD tendons. Results The dTMs was identified in 12 shoulders (75%). It was always distal to the TM tendon and visible during the deltopectoral approach. There was a clear separation between the TM proximally and dTMs tendon distally. At the humeral insertion, both tendons had a common epimyseal sheet around the teres major and inserted continuously at the humerus. The mean width of the dTMs tendon at the insertion was 13 ± 4 mm (range, 7–22 mm). The total lengths of the dTMs tendon and LD tendon were 40 ± 7 mm (range, 25–57 mm) and 69 ± 7 mm (range, 57–79 mm), respectively (p < 0.001). The dTMs muscle showed direct adhesions in ten shoulders (83%) with the LD muscle. Conclusions This is the first macroscopic description of an additional distal slip of the teres major muscle. The dTMs has a separate (distal) but continuous (mediolateral) insertion at the humerus within a common epimyseal sheet around the TM. The dTMs tendon is visible during the deltopectoral approach and can therefore provide a lead structure, particularly in ventral LD transfers with the deltopectoral approach.