Double Versus Single Tendon Transfers to Improve Shoulder Function in Brachial Plexus Birth Palsy

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Reconstructive surgery

Background:

• Brachial plexus birth palsy (BPBP) often requires surgical intervention to improve shoulder function.
• Tendon transfers are utilized to augment shoulder external rotation in affected children.
• The comparative outcomes of combined latissimus dorsi and teres major (cLT) versus isolated teres major (iTM) tendon transfers remain unclear.

Purpose of the Study:

• To compare the effectiveness of cLT versus iTM tendon transfers for improving shoulder external rotation in children with BPBP.
• To analyze functional outcomes, including external and internal rotation, using the Modified Mallet Scale (mMS).
• To evaluate the incidence of midline function loss following each type of tendon transfer.

Main Methods:

• Retrospective review of patients with BPBP undergoing shoulder tendon transfers for external rotation.
• Exclusion criteria included limited follow-up, specific palsy levels, prior surgeries, and recurrent subluxation.
• Matched cohorts based on preoperative function and alignment were created for cLT and iTM groups.
• Outcomes were assessed using mMS and Active Movement Scale scores.

Main Results:

• Both cLT and iTM transfers improved mMS external rotation (P<0.001) but decreased internal rotation (P<0.001).
• The cLT group demonstrated a statistically significant greater improvement in mMS external rotation compared to the iTM group (P=0.025).
• Loss of midline function occurred in 35.7% of cLT patients versus 14.3% of iTM patients.

Conclusions:

• Both cLT and iTM tendon transfers effectively augment shoulder external rotation in children with C5-C6 BPBP.
• cLT transfers may provide superior external rotation gains, but carry a higher risk of losing midline function.
• iTM transfers may be a preferred option when preserving midline function is a primary concern.