Combined latissimus dorsi and teres major tendon transfers for external rotation deficiency in reverse shoulder arthroplasty.

Treatment of rotator cuff deficient shoulders continues to evolve. Reverse total shoulder arthroplasty has proven effective for restoring forward elevation and abduction in patients who suffer from pseudoparalysis secondary to rotator cuff insufficiency. Unfortunately, reverse total shoulder arthroplasty is less effective at restoring lost external rotation function in patients with deficient posterior rotator cuff tissue. Therefore, functional results of reverse arthroplasty in patients who demonstrate preoperative lag signs is inferior to patients with functioning posterior rotator cuff musculature. Combined latissimus dorsi and teres major tendon transfers have been shown to be effective treatment for patients with isolated loss of external rotation. These transfers have also been shown to improve functional results in patients who undergo reverse arthroplasty and have combined loss of forward elevation and external rotation preoperatively. Previously published studies have evaluated the combined reverse arthroplasty and tendon transfer procedure only in patients with first generation (medial center of rotation) implants. We reviewed our experience with the combined procedure utilizing a third generation (medial center of rotation glenoid and lateral center of rotation humerus) device.