Abstract
Purpose
Teres minor atrophy occurs either in isolation, associated with other rotator cuff muscle pathologies or in quadrilateral space syndrome. In the latter condition, compression of the axillary nerve is the likely cause; however, the anatomy of the nerve to teres minor and how this may relate to isolated teres minor atrophy have not been extensively investigated. In light of the significance of teres minor atrophy in shoulder pathology, we performed a combined radiological and anatomical study of teres minor and its nerve supply.
Methods
Cadaveric dissection of nine shoulder specimens from eight cadavers was performed to investigate the anatomical variability in course, length and branching pattern of both the teres minor nerve and the axillary nerve. Radiological imaging and reports were analysed on all shoulder magnetic resonance images performed over a 1-week period at four radiology clinic locations in an attempt to identify the incidence of isolated teres minor atrophy and review teres minor atrophy in association with other shoulder pathology. Finally, we studied a case of isolated teres minor atrophy identified during a routine undergraduate dissection class.
Results
Considerable anatomical variation was noticed in cadaver dissections in the nerve(s) supplying teres minor muscle revealing several various points where it may be vulnerable to impingement or injury at along its course. Analysis of 61 shoulder MR images revealed two patients with shoulder complaints that had isolated teres minor atrophy. Case-based study of these two male patients revealed other associated shoulder injury but the presentation was markedly different and clinically distinct from quadrilateral space syndrome.
Conclusion
Isolated teres minor atrophy is a relatively common shoulder pathology which appears to be clinically distinct from other syndromes with rotator cuff muscle atrophy including quadrilateral space syndrome. The exact aetiology is unknown but cadaveric dissection in this study suggests the considerable anatomical variation in both the origin and length of teres minor nerve(s) increase the risk of impingement and subsequent isolated teres minor atrophy.
Similar content being viewed by others
References
Ball CM, Steger T, Galatz LM, Yamaguchi K (2003) The posterior branch of the axillary nerve: an anatomical study. J Bone Joint Surgery Am 85:1497–1501
Burley S, Masters S (2007) Shoulder pain. Aust Fam Physician 36:385–480
Cahill BR, Palmer RE (1983) Quadrilateral space syndrome. J Hand Surg 8:63–69
Drake RL, Mitchell AWM, Vogl W (2005) Gray’s anatomy for students. Elsevier/Churchill Livingstone, Philadelphia
Duparc F, Bocquet G, Simonet J, Freger P (1997) Anatomical basis of the variable aspects of injuries of the axillary nerve (excluding the terminal branches in the deltoid muscle). Surg Radiologic Anat 19:127–132
Lehtinen JT, Tingart MJ, Apreleva M, Zurakowski D, Palmer W, Warner JJP (2003) Practical assessment of rotator cuff muscle volumes using shoulder MRI. Acta Orthop Scand 74:722–729
Loukas M, Grabska J, Tubbs RS, Apaydin N, Jordan R (2009) Mapping the axillary nerve within the deltoid muscle. Surg Radiol Anat 31:43–47
Linker CS, Helms CA, Fritz RC (1993) Quadrilateral space syndrome: findings at MR imaging. Radiology 188:675–676
McCarty EC, Warren RF, Deng XH, Craig EV, Potter H (2004) Temperature along the axillary nerve during radiofrequency-induced thermal capsular shrinkage. Am J Sports Med 32:909–914
Sofka CM, Haddad ZK, Adler RS (2004) Detection of muscle atrophy on routine sonography of the shoulder. J Ultrasound Med 23:1031–1034
Sofka CM, Lin J, Feinberg J, Potter H (2004) Teres minor denervation on routine magnetic resonance imaging of the shoulder. Skeletal Rad 33:514–518
Tubbs RS, Tyler-Kabara EC, Aikens AC, Martin JP, Weed LL, Salter EG, Oakes WJ (2005) Surgical anatomy of the axillary nerve within the quadrangular space. J Neurosurg 102(5):912–914
Uz A, Apaydin N, Bozkuit M, Elhan A (2007) The anatomic branch pattern of the axillary nerve. J Shoulder Elbow Surg 16:240–244
Warwick R, Williams PL (1973) Gray’s anatomy, 35th edn. Longman, London, p 1039
Wilson L, Sundaram M, Piraino DW, Ilaslan H, Recht MP (2006) Isolated teres minor atrophy: manifestation of quadrilateral space syndrome or traction injury to the axillary nerve. Orthopedics 29:447–450
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Friend, J., Francis, S., McCulloch, J. et al. Teres minor innervation in the context of isolated muscle atrophy. Surg Radiol Anat 32, 243–249 (2010). https://doi.org/10.1007/s00276-009-0605-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-009-0605-9