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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">What is the Best Clinical Test for Assessment of the Teres Minor in Massive Rotator Cuff Tears?</title><author><name sortKey="Collin, Philippe" sort="Collin, Philippe" uniqKey="Collin P" first="Philippe" last="Collin">Philippe Collin</name><affiliation><nlm:aff id="Aff1">Saint-Grégoire Private Hospital Center, Saint-Grégoire Cedex, France</nlm:aff></affiliation></author><author><name sortKey="Treseder, Thomas" sort="Treseder, Thomas" uniqKey="Treseder T" first="Thomas" last="Treseder">Thomas Treseder</name><affiliation><nlm:aff id="Aff2">Royal Melbourne Hospital, Parkville, Melbourne, Australia</nlm:aff></affiliation></author><author><name sortKey="Denard, Patrick J" sort="Denard, Patrick J" uniqKey="Denard P" first="Patrick J." last="Denard">Patrick J. Denard</name><affiliation><nlm:aff id="Aff3">Southern Oregon Orthopedics, Medford, OR USA</nlm:aff></affiliation><affiliation><nlm:aff id="Aff4">Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR USA</nlm:aff></affiliation></author><author><name sortKey="Neyton, Lionel" sort="Neyton, Lionel" uniqKey="Neyton L" first="Lionel" last="Neyton">Lionel Neyton</name><affiliation><nlm:aff id="Aff5">Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Lyon, France</nlm:aff></affiliation></author><author><name sortKey="Walch, Gilles" sort="Walch, Gilles" uniqKey="Walch G" first="Gilles" last="Walch">Gilles Walch</name><affiliation><nlm:aff id="Aff5">Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Lyon, France</nlm:aff></affiliation></author><author><name sortKey="L Dermann, Alexandre" sort="L Dermann, Alexandre" uniqKey="L Dermann A" first="Alexandre" last="L Dermann">Alexandre L Dermann</name><affiliation><nlm:aff id="Aff6">Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Av. J.-D. Maillard 3, 1217 Meyrin, Switzerland</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26066066</idno><idno type="pmc">4523548</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4523548</idno><idno type="RBID">PMC:4523548</idno><idno type="doi">10.1007/s11999-015-4392-9</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000994</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000994</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">What is the Best Clinical Test for Assessment of the Teres Minor in Massive Rotator Cuff Tears?</title><author><name sortKey="Collin, Philippe" sort="Collin, Philippe" uniqKey="Collin P" first="Philippe" last="Collin">Philippe Collin</name><affiliation><nlm:aff id="Aff1">Saint-Grégoire Private Hospital Center, Saint-Grégoire Cedex, France</nlm:aff></affiliation></author><author><name sortKey="Treseder, Thomas" sort="Treseder, Thomas" uniqKey="Treseder T" first="Thomas" last="Treseder">Thomas Treseder</name><affiliation><nlm:aff id="Aff2">Royal Melbourne Hospital, Parkville, Melbourne, Australia</nlm:aff></affiliation></author><author><name sortKey="Denard, Patrick J" sort="Denard, Patrick J" uniqKey="Denard P" first="Patrick J." last="Denard">Patrick J. Denard</name><affiliation><nlm:aff id="Aff3">Southern Oregon Orthopedics, Medford, OR USA</nlm:aff></affiliation><affiliation><nlm:aff id="Aff4">Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR USA</nlm:aff></affiliation></author><author><name sortKey="Neyton, Lionel" sort="Neyton, Lionel" uniqKey="Neyton L" first="Lionel" last="Neyton">Lionel Neyton</name><affiliation><nlm:aff id="Aff5">Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Lyon, France</nlm:aff></affiliation></author><author><name sortKey="Walch, Gilles" sort="Walch, Gilles" uniqKey="Walch G" first="Gilles" last="Walch">Gilles Walch</name><affiliation><nlm:aff id="Aff5">Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Lyon, France</nlm:aff></affiliation></author><author><name sortKey="L Dermann, Alexandre" sort="L Dermann, Alexandre" uniqKey="L Dermann A" first="Alexandre" last="L Dermann">Alexandre L Dermann</name><affiliation><nlm:aff id="Aff6">Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Av. J.-D. Maillard 3, 1217 Meyrin, Switzerland</nlm:aff></affiliation></author></analytic><series><title level="j">Clinical Orthopaedics and Related Research</title><idno type="ISSN">0009-921X</idno><idno type="eISSN">1528-1132</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Few studies define the clinical signs to evaluate the integrity of teres minor in patients with massive rotator cuff tears. CT and MRI, with or without an arthrogram, can be limited by image quality, soft tissue density, motion artifact, and interobserver reliability. Additionally, the ill-defined junction between the infraspinatus and teres minor and the larger muscle-to-tendon ratio of the teres minor can contribute to error. Therefore, we wished to determine the validity of clinical testing for teres minor tears.</p></sec><sec><title>Question/Purposes</title><p>The aim of this study was to determine the accuracy of commonly used clinical signs (external rotation lag sign, drop sign, and the Patte test) for diagnosing the teres minor’s integrity.</p></sec><sec><title>Methods</title><p>We performed a prospective evaluation of patients referred to our shoulder clinic for massive rotator cuff tears determined by CT arthrograms. The posterosuperior rotator cuff was examined clinically and correlated with CT arthrograms. We assessed interobserver reliability for CT assessment and used three different clinical tests of teres minor function (the external rotation lag sign, drop sign, and the Patte test). One hundred patients with a mean age of 68 years were available for the analysis.</p></sec><sec><title>Results</title><p>The most accurate test for teres minor dysfunction was an external rotation lag sign greater than 40°, which had a sensitivity of 100% (95% CI, 80%–100%) and a specificity of 92% (95% CI, 84%–96%). External rotation lag signs greater than 10° had a sensitivity of 100% (95% CI, 80%–100%) and a specificity of 51% (95% CI, 40%–61%). The Patte sign had a sensitivity of 93% (95% CI, 70%–99%) and a specificity of 72% (95% CI, 61%–80%). The drop sign had a sensitivity of 87% (95% CI, 62%–96%) and a specificity of 88% (95% CI, 80%–93%). An external rotation lag sign greater than 40° was more specific than an external rotation lag sign greater than 10° (p < 0.001), and a Patte sign (p < 0.001), but was not more specific than the drop sign (p < 0.47). There was poor correlation between involvement of the teres minor and loss of active external rotation.</p></sec><sec><title>Conclusions</title><p>Clinical signs can predict anatomic patterns of teres minor dysfunction with good accuracy in patients with massive rotator cuff tears. This study showed that the most accurate test for teres minor dysfunction is an external rotation lag sign and that most patients’ posterior rotator cuff tears do not lose active external rotation. Because imaging is not always accurate, examination for integrity of the teres minor is important because it may be one of the most important variables affecting the outcome of reverse shoulder arthroplasty for massive rotator cuff tears, and the functional effects of tears in this muscle on day to day activities can be significant. Additionally, teres minor integrity affects the outcomes of tendon transfers, therefore knowledge of its condition is important in planning repairs.</p></sec><sec><title>Level of Evidence</title><p>Level III, diagnostic study.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Clin Orthop Relat Res</journal-id><journal-id journal-id-type="iso-abbrev">Clin. Orthop. Relat. Res</journal-id><journal-title-group><journal-title>Clinical Orthopaedics and Related Research</journal-title></journal-title-group><issn pub-type="ppub">0009-921X</issn><issn pub-type="epub">1528-1132</issn><publisher><publisher-name>Springer US</publisher-name><publisher-loc>New York</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26066066</article-id><article-id pub-id-type="pmc">4523548</article-id><article-id pub-id-type="publisher-id">4392</article-id><article-id pub-id-type="doi">10.1007/s11999-015-4392-9</article-id><article-categories><subj-group subj-group-type="heading"><subject>Clinical Research</subject></subj-group></article-categories><title-group><article-title>What is the Best Clinical Test for Assessment of the Teres Minor in Massive Rotator Cuff Tears?</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Collin</surname><given-names>Philippe</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Treseder</surname><given-names>Thomas</given-names></name><degrees>MD, PhD</degrees><xref ref-type="aff" rid="Aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Denard</surname><given-names>Patrick J.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="Aff3"></xref><xref ref-type="aff" rid="Aff4"></xref></contrib><contrib contrib-type="author"><name><surname>Neyton</surname><given-names>Lionel</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="Aff5"></xref></contrib><contrib contrib-type="author"><name><surname>Walch</surname><given-names>Gilles</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="Aff5"></xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Lädermann</surname><given-names>Alexandre</given-names></name><degrees>MD</degrees><address><email>alexandre.laedermann@gmail.com</email></address><xref ref-type="aff" rid="Aff6"></xref></contrib><aff id="Aff1"><label></label>Saint-Grégoire Private Hospital Center, Saint-Grégoire Cedex, France</aff><aff id="Aff2"><label></label>Royal Melbourne Hospital, Parkville, Melbourne, Australia</aff><aff id="Aff3"><label></label>Southern Oregon Orthopedics, Medford, OR USA</aff><aff id="Aff4"><label></label>Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR USA</aff><aff id="Aff5"><label></label>Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Lyon, France</aff><aff id="Aff6"><label></label>Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Av. J.-D. Maillard 3, 1217 Meyrin, Switzerland</aff></contrib-group><pub-date pub-type="epub"><day>12</day><month>6</month><year>2015</year></pub-date><pub-date pub-type="ppub"><month>9</month><year>2015</year></pub-date><volume>473</volume><issue>9</issue><fpage>2959</fpage><lpage>2966</lpage><history><date date-type="received"><day>23</day><month>10</month><year>2014</year></date><date date-type="accepted"><day>1</day><month>6</month><year>2015</year></date></history><permissions><copyright-statement>© The Association of Bone and Joint Surgeons® 2015</copyright-statement></permissions><abstract id="Abs1"><sec><title>Background</title><p>Few studies define the clinical signs to evaluate the integrity of teres minor in patients with massive rotator cuff tears. CT and MRI, with or without an arthrogram, can be limited by image quality, soft tissue density, motion artifact, and interobserver reliability. Additionally, the ill-defined junction between the infraspinatus and teres minor and the larger muscle-to-tendon ratio of the teres minor can contribute to error. Therefore, we wished to determine the validity of clinical testing for teres minor tears.</p></sec><sec><title>Question/Purposes</title><p>The aim of this study was to determine the accuracy of commonly used clinical signs (external rotation lag sign, drop sign, and the Patte test) for diagnosing the teres minor’s integrity.</p></sec><sec><title>Methods</title><p>We performed a prospective evaluation of patients referred to our shoulder clinic for massive rotator cuff tears determined by CT arthrograms. The posterosuperior rotator cuff was examined clinically and correlated with CT arthrograms. We assessed interobserver reliability for CT assessment and used three different clinical tests of teres minor function (the external rotation lag sign, drop sign, and the Patte test). One hundred patients with a mean age of 68 years were available for the analysis.</p></sec><sec><title>Results</title><p>The most accurate test for teres minor dysfunction was an external rotation lag sign greater than 40°, which had a sensitivity of 100% (95% CI, 80%–100%) and a specificity of 92% (95% CI, 84%–96%). External rotation lag signs greater than 10° had a sensitivity of 100% (95% CI, 80%–100%) and a specificity of 51% (95% CI, 40%–61%). The Patte sign had a sensitivity of 93% (95% CI, 70%–99%) and a specificity of 72% (95% CI, 61%–80%). The drop sign had a sensitivity of 87% (95% CI, 62%–96%) and a specificity of 88% (95% CI, 80%–93%). An external rotation lag sign greater than 40° was more specific than an external rotation lag sign greater than 10° (p < 0.001), and a Patte sign (p < 0.001), but was not more specific than the drop sign (p < 0.47). There was poor correlation between involvement of the teres minor and loss of active external rotation.</p></sec><sec><title>Conclusions</title><p>Clinical signs can predict anatomic patterns of teres minor dysfunction with good accuracy in patients with massive rotator cuff tears. This study showed that the most accurate test for teres minor dysfunction is an external rotation lag sign and that most patients’ posterior rotator cuff tears do not lose active external rotation. Because imaging is not always accurate, examination for integrity of the teres minor is important because it may be one of the most important variables affecting the outcome of reverse shoulder arthroplasty for massive rotator cuff tears, and the functional effects of tears in this muscle on day to day activities can be significant. Additionally, teres minor integrity affects the outcomes of tendon transfers, therefore knowledge of its condition is important in planning repairs.</p></sec><sec><title>Level of Evidence</title><p>Level III, diagnostic study.</p></sec></abstract><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Association of Bone and Joint Surgeons® 2015</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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