Trapezius transfer after brachial plexus palsy: Indications, difficulties and complications

Rühmann, O.; Wirth, Carl Joachim; Gossé, F.; Schmolke, S.

doi:10.1302/0301-620x.80b1.8195

Cited by 33 publications

(27 citation statements)

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“…The average active mobility was as follows: flexion 77˚, active abduction 75.8˚, external rotation 57˚, and internal rotation at the first lumbar vertebra (L1) ( Table 1). The average postoperative University of California at Los Angeles (UCLA) [14] functional outcome was 22 points. The functional outcome according to Ellman's [15] 4-level scale (excellent, good, fair, poor) was fair.…”

Section: Resultsmentioning

confidence: 99%

“…The following conditions were, however, required to be fulfilled: complete paralysis of the deltoid and supraspinatus confirmed by a clinical ENMG examination, strength level of V degrees of the trapezius muscle, passive abduction greater than 80˚, and no signs of arthrosis in the joints [9]. All patients were clinically assessed postoperatively by functional criteria of the University of California at Los Angeles (UCLA) [14].…”

Section: Methodsmentioning

confidence: 99%

“…Muscle transfer enhances the function and stability of the shoulder in paralysis of the deltoid and supraspinatus [12]. The other treatment option, arthrodesis, also restores stability; however, its indication is limited and it is less suitable as the first treatment option for treatment in cases of paralysis of the deltoid [5,13].…”

Section: Introductionmentioning

confidence: 99%

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Transfer of the Trapezius to the Deltoid for Treatment of Shoulder Instability after Lesions of the Brachial Plexus

Severo¹,

Maia²,

Lemos³

et al. 2013

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Objective: To clarify the indications and to describe the surgical technique and outcomes of surgery involving transfer of the trapezius to the deltoid for the treatment of lesions of the brachial plexus in patients with multidirectional instability in the shoulder. Method: In 17 patients (mean age, 23 years) operated at São Vicente de Paulo Hospital and the Institute of Orthopedics and Traumatology of Passo Fundo, Brazil from 1999 to 2009, we performed trapezius transfer to the proximal humerus. In these patients, the mean interval between trauma and surgery was 8 months. Results: Functional improvement and resolution of multidirectional instability of the shoulder were observed in all the patients. No patient showed immediate postoperative complications. The mean active mobility was as follows: 95˚ flexion, 50˚ abduction, 45˚ external rotation, and internal rotation at the level of the first lumbar vertebra (L1). The trapezius muscle strength was classified as grade III, and the UCLA functional outcome was 22 points. The postoperative satisfaction was excellent, and occasional pain and weakness was reported by all the patients. Conclusions: Transfer of the trapezius muscle to the proximal humerus provides better results in patients with a more than 6-monthold lesion. This procedure also preserves passive mobility of the limb, confers shoulder stability, provides active mobility, and prevents osteoarthrosis.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Transfer of the Trapezius to the Deltoid for Treatment of Shoulder Instability after Lesions of the Brachial Plexus

Severo¹,

Maia²,

Lemos³

et al. 2013

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“…The trapezius muscle must show full strength against resistance. To carry out the transfer it is essential that the preoperative passive shoulder abduction is at least 80° [22].…”

Section: Muscle Transfersmentioning

confidence: 99%

“…Fixation was provided by two 6.5-mm cancellous screws, with the shoulder positioned in abduction from 80° to 90°. Since that time, Saha's Rühmann et al have several publications on trapezius transfer in adult brachial plexus injury [17,22,23]. Originally, Rühmann used Saha's technique; then, he modified the method by suturing the partially freed deltoid muscle under maximum tension on top of the trapezius as far medially as possible.…”

Section: Operative Technique Evolution Upper Trapezius Transfer Technmentioning

confidence: 99%

Role of Trapezius Transfer for Shoulder Reconstruction in Adult Traumatic Brachial Plexus Injuries: Literature Review

Salama¹,

Omar²

2018

IMJ

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IntroductionShoulder instability and lack of shoulder mobility are common and exhausting problems in adult patients with traumatic brachial plexus injuries. Even with functioning elbow, wrist, and fingers, upper limb function is significantly hampered by deficient shoulder function. Primary nerve reconstruction remains the "gold standard" in brachial plexus management. If surgery is early and successful, adequate reinnervation of the deltoid, teres minor, supraspinatus and infraspinatus muscles can be achieved, as well as glenohumeral joint stability [1,2].However, secondary shoulder reconstruction is needed in clinical scenarios, such as neglected cases (>1 year without any attempt for reconstruction) and cases of complete or partial failure of recovery of both the deltoid and rotator cuff after primary reconstruction.Many options are available for secondary shoulder reconstruction. Trapezius transfer is one of those important options, and our goal is to review the indications, techniques, and outcomes of trapezius transfer and compare it with the alternative options. First, we should revisit the basic concepts of shoulder kinematics and tendon transfer. Kinematics of the ShoulderThe shoulder range of motion is achieved by the scapulohumeral rhythm, which is the coordinated motion of the glenohumeral, scapulothoracic, acromioclavicular and sternoclavicular joints. For shoulder abduction, an approximately 2:1 ratio of glenohumeral to scapulothoracic motion is required [3][4][5].The rotator cuff muscles are primarily dynamic stabilizers for the shoulder during abduction, forward flexion, and extension that act by resisting the relative upward shearing moment at the glenohumeral joint by the deltoid in early abduction and through a force couple of the subscapularis anteriorly and the infraspinatus posteriorly [6].The importance of the force couple function generated by the glenohumeral stabilizers is indicated by the pseudoparalysis of the shoulder in massive rotator cuff tear. This pseudoparalysis extends below the humeral head equator despite normal brachial plexus and deltoid function; however, due to the force couple loss, the humeral head cannot be contained. An important study done by Gerber et al. demonstrated 45% loss of abduction strength and 70% loss of external rotation strength after nerve blocks of the infraspinatus. Paralysis of both the supraspinatus and infraspinatus led to a decrease in abduction strength of 75% and a decrease in external rotation strength of 80%. The teres minor plays a role in external rotation strength at any angle of shoulder abduction less than 20% [7].These relations explain why isolated trapezius transfer alone leads to an obligatory proximal migration of the humeral head, narrowing the space between the humeral head and acromion, which causes mechanical impingement and decreases the trapezius lever arm, leading to ineffective shoulder abduction and flexion [8].The deltoid and rotator cuff muscles have relatively low excursion but generate high tension. The upper trapezius ...

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Secondary reanimation procedures in late obstetrical brachial plexus palsy patients

et al. 2006

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The varying degrees of spontaneous reinnervation that occur in untreated obstetrical brachial plexus palsy leave characteristic deformities of the shoulder, elbow, forearm, wrist, and hand. Common sequelae are internal rotation and adduction deformity of the shoulder, elbow flexion contractures, forearm supination deformity, and lack of wrist extension and finger flexion. Early microsurgical reconstruction of the affected plexus leads to a more rewarding overall function of the upper arm, but residual deformities might appear later which are similar, although less serious, than those observed in untreated cases. Secondary procedures of the shoulder, elbow, forearm, and hand will improve the appearance and function of the upper extremity in late cases of obstetrical brachial plexus. Careful preoperative planning is mandatory and a multistage approach should be applied, depending on the type of palsy and the age of the patient.

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Trapezius transfer after brachial plexus palsy: Indications, difficulties and complications

Cited by 33 publications

References 0 publications

Transfer of the Trapezius to the Deltoid for Treatment of Shoulder Instability after Lesions of the Brachial Plexus

Transfer of the Trapezius to the Deltoid for Treatment of Shoulder Instability after Lesions of the Brachial Plexus

Role of Trapezius Transfer for Shoulder Reconstruction in Adult Traumatic Brachial Plexus Injuries: Literature Review

Secondary reanimation procedures in late obstetrical brachial plexus palsy patients

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