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Reverse total shoulder – Are latissiumus or teres major transfers beneficial for patients who have lost elevation and external rotation together?


To address Combined Loss Of Elevation and External Rotation (CLEER), some authors advocate that latissimus Dorsi (LD), and teres Major (TM) tendon transfer be performed simultaneously with reverse shoulder arthroplasty. 

The authors of Reverse shoulder arthroplasty with and without latissimus and teres major transfer for patients with combined loss of elevation and external rotation: a prospective, randomized investigation sought to compare RSA outcomes in patients with rotator cuff tear arthropathy and CLEER in a randomized controlled study using RSAs without (below left) and with (below right) LD-TM tendon transfer using implants that lateralized the greater tuberosity.

The primary outcome measure was the two year postoperative Activities of Daily Living and External Rotation (ADLER) score as described by the authors of Modified latissimus dorsi and teres major transfer through a single delto-pectoral approach for external rotation deficit of the shoulder: as an isolated procedure or with a reverse arthroplasty

Secondary outcome measures were the Disabilities of the arm, shoulder and hand (DASH), score from American Shoulder and Elbow Surgeons and score from Simple Shoulder Test (SST).

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