Teres minor, anatomy, clinical examination for tear

1. CLINICAL TEST FOR TERES
MINOR TEAR
Dr.Madhavan

2. LESSON PLAN
• Name of the lecturer :Dr. MADHAVAN
• Date :27/07/2020
• Class: Orthopaedic Post Graduates, interns
• Number of students : 24
• Time :8mins
• Subject : Orthopaedics
• Topic :CLINICAL TEST FOR TERES MINOR
TEAR

3. SPECIFIC LEARNING
OBJECTIVES
• Each Students should be able to
1. Describe the anatomy, Embryology, blood and nerve supply,
function of teres minor.
2. Describe the injury of teres minor and to demonstrate the
clinical test to assess teres minor tear
At the end of the class, With out mistakes

4. Sl
no
Content Method and
media
Time
taken
Evaluation
1 • Anatomy
• Embryology
• Blood and nerve
supply
• Function
Power point
presentation
3 Questions
and answers
2. Teres minor injury Power point
presentation
2 Questions
and answers
3. Clinical test to asses the
teres minor injury
Power point
presentation
3 Questions
and answers
Assignment :All students should able to demonstrate test to
asses the teres minor tear at the end of the class

5. ANATOMY
• The teres minor arises from the posterior surface of
the scapula
• The tendon blends into the capsule of the shoulder
joint
• The lower fibers of the muscle insert directly into
the humerus, just below the greater tubercle.
• The teres minor lies inferior to the infraspinatus and
superior to the teres major

9. EMBRYOLOGY
• Arises from the myotome of paraxial
mesoderm
• Posterior condensation gives rise to teres
minor and Well-established by 8 weeks.

10. NERVE AND BLOOD SUPPLY
The axillary nerve, composed of nerve roots C5 and C6, arises from the posterior cord of the
brachial plexus.

13. FUNCTIONS
• Teres minor stabilizes the ball-and-socket
glenohumeral joint
• It laterally or externally 45%, rotate the arm at the
shoulder joint
• Stabilizing the shoulder during medial rotation to
prevent anterior dislocation of the humerus.

14. • The effect of deltoid is mainly upwards and, unless
opposed, this would displace the humerus upwards
• Subscapularis, supraspinatus, infraspinatus and teres
minor exert a centralizing force and so apply a
balancing force; together with deltoid, they
constitute a ‘couple’ to produce abduction in the
scapular plane.

15. COUPLING

16. • Lateral rotation is important for clearance of
the greater tubercle and its associated tissues
as it passes under the coraco-acromial arch
during elevation of the arm.

17. TEAR
• An acute tear usually results from falling on an
outstretched arm or an attempt to lift something
heavy.
• A chronic tear occurs over time and is usually
secondary to tendinitis or shoulder impingement
syndrome wearing away at the muscle
• The rotator cuff tendinitis:The patient will present
with pain or clicking when raising the arm above
the head

18. Hornblower’s sign can be used to assess the teres minor for injury,
particularly a tear. The patient’s arm should be placed to 90 degrees in
the scapular plane with the elbow flexed to 90 degrees. The patient will
then externally rotate against resistance, trying to make a “field goal”
sign. The test is positive if the patient cannot externally rotate the
shoulder, indicating teres minor pathology.

19. A)The external rotation lag sign is performed with the patient seated with the elbow
flexed to 90° and the shoulder elevated 20° in the scapular plane. The arm is passively
taken to maximal external rotation minus 5° to allow for elastic recoil. (B) The patient
was asked to maintain that position as the clinician released the wrist. A positive test is
defined as any internal rotation greater than 10°.
external rotation lag sign greater than 40°, which had a sensitivity of
100% and a specificity of 92%

20. (A) The Patte test is performed by passively taking the arm from a
starting point of 90° abduction in the scapular plane and an elbow
flexion of 90° without external rotation. (B) The patient is asked to
perform external rotation of the shoulder from this position against
resistance. A positive Patte test is defined as external rotation power less
The Patte sign had a sensitivity of 93% and a specificity of 72%

21. (A) The drop sign is a lag sign beginning from 90° abduction in the
scapular plane, with elbow flexion of 90°, and external rotation of the
shoulder to 90°. From this position, the patient is asked to maintain the
position against gravity. (B) Failure to resist gravity and internal rotation
of the arm is considered a positive drop sign.
The drop sign had a sensitivity of 87% and a specificity of 88%

23. • Thank you