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Sonography of the Teres Minor: A Study of Cadavers

Hyun-Min Kim1, Nirvikar Dahiya2, Sharlene A. Teefey2, Jay D. Keener1 and Ken Yamaguchi1

1 Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO 63110.
2 Abdominal Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd., St. Louis, MO 63110.


Figure 1
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  		Fig. 1 —Longitudinal view of teres minor was obtained with transducer placed parallel to direction of teres minor muscle fibers over posterior glenohumeral joint line. Because of oblique course of teres minor, transducer was at a 30° angle to scapular spine. AC = acromion, SP = scapular spine.

 

Figure 2
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  		Fig. 2 —Transverse view of teres minor was obtained with transducer placed perpendicular to direction of teres minor muscle fibers over posterior humeral head. AC = acromion, SP = scapular spine.

 

Figure 3
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  		Fig. 3A —Longitudinal sonograms of infraspinatus and teres minor at insertions on humeral head. GL = glenoid, HH = humeral head, IST = infraspinatus tendon, TM = teres minor tendon, DT = deltoid. Sonogram shows infraspinatus has long, wedge-shaped insertion.

 

Figure 4
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  		Fig. 3B —Longitudinal sonograms of infraspinatus and teres minor at insertions on humeral head. GL = glenoid, HH = humeral head, IST = infraspinatus tendon, TM = teres minor tendon, DT = deltoid. Sonogram shows teres minor has rather quadrangular-shaped insertion.

 

Figure 5
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  		Fig. 4 —Transverse sonogram of teres minor muscle–tendon unit shows characteristic oblong contour. HH = humeral head, SN = surgical neck of the humerus, TM = teres minor muscle–tendon unit, DT = deltoid.

 

Figure 6
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  		Fig. 5A —Teres minor shown during dissection after sonographically guided dye injection. HH = humeral head, IST = infraspinatus, TM = teres minor. Photograph shows superior margin has narrow fatty streak (white arrow), which facilitates distinction between infraspinatus and teres minor insertions. Methylene blue (black arrows) was injected directly into superior and inferior margins of teres minor insertion.

 

Figure 7
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  		Fig. 5B —Teres minor shown during dissection after sonographically guided dye injection. HH = humeral head, IST = infraspinatus, TM = teres minor. Photograph after removal of infraspinatus and joint capsule shows teres minor insertion is now well visualized. Arrows indicate methylene blue dye injected into superior and inferior margins of teres minor insertion.

 

Figure 8
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  		Fig. 6 —Photograph shows width of teres minor insertion measured during dissection was almost identical to measurements on sonography in all specimens. TM = teres minor.

 

Figure 9
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  		Fig. 7A —Full-thickness artificial tear created with arthroscopy. HH = humeral head, SN = surgical neck, IST = infraspinatus, TM = remaining part of teres minor. On longitudinal (A) and transverse (B) sonograms, tear (arrow) appears as hypoechoic defect near teres minor insertion.

 

Figure 10
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  		Fig. 7B —Full-thickness artificial tear created with arthroscopy. HH = humeral head, SN = surgical neck, IST = infraspinatus, TM = remaining part of teres minor. On longitudinal (A) and transverse (B) sonograms, tear (arrow) appears as hypoechoic defect near teres minor insertion.

 

Figure 11
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  		Fig. 7C —Full-thickness artificial tear created with arthroscopy. HH = humeral head, SN = surgical neck, IST = infraspinatus, TM = remaining part of teres minor. Photograph shows corresponding tear (arrow) after dissection. Tear was created approximately 0.5-cm medial to insertion.

 

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