Trapezius transfer for shoulder paralysis: 6 patients with brachial plexus injuries followed for 1 year

Mir-Bulló, Xavier; Hinarejos, Pedro; Mir-Batlle, Pedro; Busquets, Rosa; Carrera, Lluís; Navarro, A.

doi:10.3109/17453679809002360

Cited by 18 publications

(13 citation statements)

References 14 publications

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“…However, our results were not as good as those of Karev 8 and Mir-Bullo et al 12 Only a combination of transferred muscles can improve the functional outcome. Narakas 19 achieved a mean abduction of 120˚ in four patients with a combined transfer of teres major, levator scapulae and latissimus dorsi.…”

Section: Discussioncontrasting

confidence: 96%

“…Our functional results after modification of the technique do not differ much from those of previous publications. 1,8,9,11,12,14,16 In all the modified operations an increase in stability was achieved and inferior subluxation was abolished, whereas in one-third of the patients in the Saha group the subluxation persisted. Inferior subluxation is a notable problem with pain arising from constant pulling on the capsule of the joint and of the adjacent structures.…”

Section: Discussionmentioning

confidence: 98%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Some authors have achieved excellent functional results with more than 75˚ of abduction and forward flexion 8,12 but in larger series these values were only 40˚ or less. 1,13,14 Our earlier experience of trapezius transfer has shown the importance of a reduction of joint instability in patients with brachial plexus palsy.…”

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confidence: 99%

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Trapezius transfer in brachial plexus palsy

Rühmann

Schmolke

Bohnsack

et al. 2005

The Journal of Bone and Joint Surgery. British volume

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Between March 1994 and June 2003, 80 patients with brachial plexus palsy underwent a trapezius transfer. There were 11 women and 69 men with a mean age of 31 years (18 to 69). Before operation a full evaluation of muscle function in the affected arm was carried out. A completely flail arm was found in 37 patients (46%). Some peripheral function in the elbow and hand was seen in 43 (54%). No patient had full active movement of the elbow in combination with adequate function of the hand. Patients were followed up for a mean of 2.4 years (0.8 to 8). We performed the operations according to Saha's technique, with a modification in the last 22 cases. We demonstrated a difference in the results according to the pre-operative status of the muscles and the operative technique. The transfer resulted in an increase of function in all patients and in 74 (95%) a decrease in multidirectional instability of the shoulder. The mean increase in active abduction was from 6 degrees (0 to 45) to 34 degrees (5 to 90) at the last review. The mean forward flexion increased from 12 degrees (0 to 85) to 30 degrees (5 to 90). Abduction (41 degrees) and especially forward flexion (43 degrees) were greater when some residual function of the pectoralis major remained (n = 32). The best results were achieved in those patients with most pre-operative power of the biceps, coracobrachialis and triceps muscles (n = 7), with a mean of 42 degrees of abduction and 56 degrees of forward flexion. Active abduction (28 degrees) and forward flexion (19 degrees) were much less in completely flail shoulders (n = 34). Comparison of the 19 patients with the Saha technique and the 15 with the modified procedure, all with complete paralysis, showed the latter operation to be superior in improving shoulder stability. In all cases a decrease in instability was achieved and inferior subluxation was abolished. The results after trapezius transfer depend on the pre-operative pattern of paralysis and the operative technique. Better results can be achieved in patients who have some function of the biceps, coracobrachialis, pectoralis major and triceps muscles compared with those who have a complete palsy. A simple modification of the operation ensures a decrease in joint instability and an increase in function.

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Section: Discussioncontrasting

confidence: 96%

Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

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Trapezius transfer in brachial plexus palsy

Rühmann

Schmolke

Bohnsack

et al. 2005

The Journal of Bone and Joint Surgery. British volume

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“…With upper trapezius transfers to the humeral head, Monreal et al10 obtained an average of 46° of abduction, a degree of improvement similar to that reported by Aziz et al,11 Kotwal et al,12 and Mir‐Bullo et al13 obtained increases of 60° and 76° of abduction, respectively. Contrary to our series, a few patients of Mir‐Bullo et al13 already had recovered up to 30° of abduction before surgery, which might explain their superior results. Kotwal et al12 did not report preoperative range of abduction.…”

Section: Discussionsupporting

confidence: 52%

Upper and lower trapezius muscle transfer to restore shoulder abduction and external rotation in longstanding upper type palsies of the brachial plexus in adults

Bertelli

2010

Microsurgery

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Lesions affecting the upper roots of the brachial plexus result in paralysis of shoulder abduction and external rotation. In longstanding lesions, neurological surgery is not recommended in which case muscle transfers become an option to improve shoulder function. We describe the surgical treatment of seven adult patients with longstanding lesions of the upper roots of the brachial plexus, in whom the upper trapezius muscle was transferred to the humeral head, whereas the lower trapezius muscle was sutured to the infraspinatous muscle tendon. Within an average of 11.7 months after surgery, patients had recovered 38° of abduction and 104° of external rotation, as measured from full internal rotation. The results of this preliminary series involving the combined transfer of both the upper and lower trapezius muscle seems promising for the treatment of chronic paralysis of abduction and external rotation following brachial plexus injury.

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“…Durch die Verpflanzung des Musculus trapezius können die Funktion und Stabilität der Schulter verbessert werden [1, 2, 4-6, 10-12, 16-18, 21, 22]. Einige Autoren berichten in Einzelfällen über exzellente funktionelle Ergebnisse mit > 75° Abduktion und Anteversion [10,16], wohingegen in größeren Serien diesbezüglich Werte von ≤ 40° angegeben werden [2,17,18,22]. Neben der Operationstechnik kann das präoperative muskuläre Ausfallmuster für diese unterschiedlichen Ergebnisse verantwortlich sein.…”

Section: Vorbemerkungenunclassified

Modifizierte Technik der Verpflanzung des Musculus trapezius zur Funktionsverbesserung bei Armplexusschäden

Rühmann

Kohn²,

Bohnsack

2008

Orthop Traumatol

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The procedure was performed in 104 cases. 80 patients were followed up on average after 2.4 years (0.8-8 years). In all cases, the transfer resulted in an increase of function and in 95% in a decrease of multidirectional shoulder instability. The modification of the original technique in the latest 22 cases was superior in terms of shoulder stability. In all these cases, a decrease of instability was achieved and inferior subluxation was abolished.

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Trapezius transfer for shoulder paralysis: 6 patients with brachial plexus injuries followed for 1 year

Abstract: (1998) Trapezius transfer for shoulder paralysis: 6 patients with brachial plexus injuries followed for 1 year, Acta Orthopaedica Scandinavica, 69:1, 69-72,

Cited by 18 publications

References 14 publications

Trapezius transfer in brachial plexus palsy

Trapezius transfer in brachial plexus palsy

Upper and lower trapezius muscle transfer to restore shoulder abduction and external rotation in longstanding upper type palsies of the brachial plexus in adults

Modifizierte Technik der Verpflanzung des Musculus trapezius zur Funktionsverbesserung bei Armplexusschäden

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