Results of Latissimus Dorsi and Teres Major Transfer to the Rotator Cuff in the Treatment of Erb's Palsy

Shoulder Function Following Late Neurolysis and Bypass Grafting for Upper Brachial Plexus Birth Injuries

“…While one may argue that these children could have been treated at a later age with a muscle-tendon transfer to improve shoulder elevation and lateral rotation, this option involves waiting and risks the development of further muscle imbalances, joint contracture, and skeletal deformity. Furthermore, the average composite gains in shoulder motion that occurs with a secondary muscle transfer (Edwards et al, 2000;Suenaga et al, 1999) is less than was obtained in this group, when calculated using the same evaluation system. In a recent report by Nehme et al (2002), which analysed the outcome following spontaneous recovery in a series of 30 infants with upper plexus injuries, 13% of infants who failed to show good recovery at 9 months ultimately progressed to this level.…”

Reverse Shoulder Arthroplasty Combined with a Modified Latissimus Dorsi and Teres Major Tendon Transfer for Shoulder Pseudoparalysis Associated with Dropping Arm

“…The combined RSA and tendon transfer is performed in the same operative session through a single deltopectoral approach with the patient in the beach chair position, obviating the need to place the patient in the lateral position and another posterior approach to harvest the tendons [12,13,15,28,31,38,40,49]. The deltopectoral approach makes the identification, dissection, and transfer of the LD/ TM tendons relatively simple and safe, because the tendons are located at the medial border of the humerus immediately behind the pectoralis major tendon.…”

“…1). Although external rotation deficit can be successfully treated with a tendon transfer, such a muscle transfer alone may be inadequate to power external rotation and elevation with such global dysfunction, and is contraindicated when arthritic changes are present [12,13,15,20,28,31,38,40,49].…”

Modified latissimus dorsi and teres major transfer through a single delto-pectoral approach for external rotation deficit of the shoulder: As an isolated procedure or with a reverse arthroplasty

“…The procedure is commonly performed in children through two incisions (anterior and posterior) or a single posterior approach. 6,17,20,37,39,49,50,54,61 Gerber et al proposed transfer of the latissimus dorsi tendon for irreparable defects of the rotator cuff; this technique also involves two incisions. [27][28][29] The goal of the procedure is to close the cuff defect and restore shoulder function; however, the reported gain in active external rotation is modest, and it is not designed for patients with a complete (negative) loss of active external rotation.…”