Trapezius transfer in brachial plexus palsy

Abstract

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.

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

“…Functional improvement and satisfaction with surgery was achieved in all the patients in our study. Similar results were obtained in studies performed by Aziz et al [9], Ruhmann et al [16,17], Monreal et al [18], Singh et al [19], and Elhassan et al [20]. The only contraindication to this technique is severe glenohumeral arthrosis , which was not encountered in the current study.…”

Biomechanical comparison between the trapezius transfer and latissimus transfer for irreparable posterosuperior rotator cuff tears

“…The amount of humeral internal rotation due to muscle loading increased with a massive cuff tear at 0 (intact, 22 At neutral humeral rotation at 0 abduction, the rotator cuff tear caused an anteriorly directed shift in force at 0 (change from intact, þ4.9 AE 5.0 N; P ¼ .0498), which was corrected by the trapezius transfer 12 N (change from intact, þ0.0 AE 4.4 N; P ¼ 1.0000), 24 N (change from intact, À2.1 AE 5.3 N; P ¼ 0.7841), and 36 N (change from intact, À4.7 AE 6.6 N; P ¼ .0706) loads (Fig. 7).…”

“…19 Transfer of the trapezius to the proximal humerus was first described more than 100 years ago to minimize inferior shoulder subluxation and to restore shoulder abduction and flexion in the paralytic shoulder, with poor results initially reported; however, most of these reports involved transfer of the upper portion of the trapezius muscle belly. 3,13,15,22,23 Isolated transfer of the lower trapezius with an Achilles tendon allograft to restore external rotation in patients with traumatic brachial plexus injuries was first described with successful results by Elhassan et al 6 Additional reports have confirmed the effectiveness of this transfer in patients with brachial plexus injuries 4-6 ; however, its use in patients with rotator cuff disease has not been reported extensively in the literature.…”

Surgical anatomy of the lower trapezius tendon transfer

“…Trapezius transfers have previously been described in the literature, with historically poor results being attributed to elongation of the fascia lata augmentation and scarring. 14,15 Of note, most early published reports involved the isolated transfer of the upper portion of the trapezius. 1,9,11,15 More recently, the lower trapezius transfer has been used successfully to improve elevation and external rotation in patients with brachial plexopathies.…”