BACKGROUND: In @entity1 with rotator cuff dysfunction, reverse shoulder arthroplasty can restore active forward flexion, but it does not provide a solution for the lack of active external rotation because of @entity409 . A modified L'Episcopo procedure can be performed in the same setting wherein the latissimus dorsi and teres major tendons are transferred to the lateral aspect of proximal humerus in an attempt to restore active external rotation. QUESTIONS/PURPOSES: (1) Do latissimus dorsi and teres major tendon transfers with reverse shoulder arthroplasty improve external rotation function in @entity1 with @entity717 ? (2) Do @entity1 experience less @entity158 and have improved outcome scores after surgery? (3) What are the complications associated with reverse shoulder arthroplasty with latissimus dorsi and teres major transfer? METHODS: Between 2007 and 2010, we treated all @entity1 undergoing shoulder arthroplasty who had a profound external rotation lag sign and advanced @entity717 (infraspinatus plus teres minor) with this approach. A total of 21 @entity1 (mean age 66 years; range, 58-82 years) were treated this way and followed for a minimum of 2 years (range, 26-81 months); none was lost to followup, and all have been seen in the last 5 years. We compared pre- and postoperative ranges of motion, @entity158 , and functional status; scores were drawn from chart review. We also categorized major and minor complications. RESULTS: Active forward flexion improved from 56      36   to 120      38   (mean difference: 64   [95% confidence interval {CI}, 45  -83  ], p < 0.001). Active external rotation with the arm adducted improved from 6      16   to 38      14   (mean difference: 30   [95% CI, 21  -39  ], p < 0.001); active external rotation with the arm abducted improved from 19      25   to 74      22   (mean difference: 44   [95% CI, 22  -65  ], p < 0.001). @entity158 visual analog score improved from 8.4    2.3 to 1.7    2.1 (mean difference: -6.9 [95% CI, -8.7 to -5.2], p < 0.001), and Single Assessment Numeric Evaluation score improved from 28%    21% to 80%    24% (mean difference: 46% [95% CI, 28%-64%], p < 0.001). There were six major complications, five of which were treated operatively. Overall, three @entity1 ' latissimus and teres major transfer failed based on persistent lack of external rotation. CONCLUSIONS: In @entity1 with posterior and superior cuff deficiency, reverse shoulder arthroplasty combined with latissimus dorsi and teres major transfer through a single deltopectoral incision can reliably increase active forward flexion and external rotation. @entity1 experience @entity158 relief and functional improvement but have a high rate of complications; therefore, we recommend the procedure be limited to @entity1 indicated for reverse who have profound external rotation loss and a high grade of infraspinatus/teres minor @entity194 . LEVEL OF EVIDENCE: Level IV, therapeutic study.

Latissimus Dorsi and Teres Major Transfer With Reverse Shoulder Arthroplasty Restores Active Motion and Reduces XXXX for Posterosuperior Cuff Dysfunction.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity409 :: ('MESH:D008107', 'Disease') :: ['infraspinatus and the teres minor dysfunction'] @entity194 :: ('MESH:D001284', 'Disease') :: ['fatty atrophy'] @entity158 :: ('MESH:D010146', 'Disease') :: ['Pain', 'pain'] @entity717 :: ('MESH:D009069', 'Disease') :: ['fatty degeneration of the posterosuperior rotator cuff', 'posterosuperior rotator cuff dysfunction']
@entity158 :: (MESH:D010146,Disease) :: ['Pain']
