The infraspinatus tendon inserts on the middle facet of the greater tuberosity immediately posterior to the supraspinatus. It is the primary external rotator of the shoulder and the most important posterior stabiliser. The infraspinatus posterior critical zone (1 cm from the musculotendinous junction) is the most common site of degeneration analogous to the supraspinatus critical zone. External rotation lag sign confirms infraspinatus tear.
External rotation force transmission; posterior glenohumeral stabilisation; compression of the humeral head into the glenoid
The external rotation lag sign (inability to hold the arm in maximum external rotation when released) confirms infraspinatus tear. Infraspinatus atrophy from suprascapular nerve palsy or massive rotator cuff tear produces the infraspinous fossa hollowing visible in thin patients. Arthroscopic infraspinatus repair uses 1-2 suture anchors in the middle facet footprint.
Posterior rotator cuff tear producing external rotation weakness and lag sign managed with arthroscopic repair and posterior capsular release for concurrent stiffness.
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