Strengthening of the partially paralyzed shoulder girdle by multiple muscle-tendon transfers

Strength and stability of the shoulder girdle affect function of the entire upper extremity. Isolated muscle weakness may be compensated for by adjacent muscles; however, profound weakness of the deltoid muscle, for example, affects not only placement of the extremity, but also strength and endurance of the forearm and hand. Orthotic substitutes for weakened muscles are not successful. If the muscle weakness is nonprogressive and stable, then surgical treatment will improve glenohumeral stability, increase endurance, and provide more uniform strength for many activities of daily living.