APEX Shoulder Mastering Surgical Techniques for Clinical Success-ER Lag

ER Lag_ When to think Lower Trap Transfer

Video Transcription

Video Summary

This presentation discusses external rotation lag sign, caused by massive rotator cuff tears disrupting the force couple, and when to consider lower trapezius tendon transfer (LTTT). Assessing the infraspinatus tendon’s reparability via MRI (Cutalier, Pate grades, and tendon length) guides treatment. Repairable tendons are fixed acutely, possibly with adjunct procedures. Irreparable tendons require dynamic reconstruction; while superior capsule reconstruction is static, tendon transfers like LTTT or latissimus dorsi transfer restore function. LTTT offers superior biomechanical advantages, being inline and in-phase with the infraspinatus, improving pain, motion, and work return in severe cases, often outperforming latissimus dorsi transfer.

Asset Caption

Jarrett Woodmass, MD

Keywords

external rotation lag sign

massive rotator cuff tears

lower trapezius tendon transfer

infraspinatus tendon reparability

superior capsule reconstruction