Lower Trapezius Tendon Transfer for Restoration of External Rotation in Brachial Plexus Birth Injury

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Brachial Plexus Injury Management

Background:

• Brachial plexus birth injuries (BPBIs) frequently cause shoulder external rotation deficits.
• Restoring shoulder external rotation is crucial for functional recovery in pediatric patients with BPBIs.
• The effectiveness of lower trapezius tendon transfer for this specific indication requires further characterization.

Purpose of the Study:

• To evaluate the utility of lower trapezius tendon transfer in pediatric patients with BPBI.
• To assess the impact of this procedure on shoulder external rotation.
• To analyze associated factors and reoperation rates.

Main Methods:

• A cohort of 17 pediatric patients with BPBI underwent lower trapezius tendon transfer.
• Mean age at surgery was 8 years; mean follow-up was 36 months.
• Preoperative and postoperative range of motion (ROM) for shoulder external rotation and forward flexion were measured.

Main Results:

• Significant improvement was observed in external rotation in adduction (4° to 26°) and abduction (75° to 84°).
• Active forward flexion showed no significant change (147° to 141°).
• 35% of patients required subsequent surgeries, with coracoid osteotomy/excision and biceps tenodesis being significant associated procedures.

Conclusions:

• Lower trapezius tendon transfer provides statistically significant, but not clinically meaningful, improvements in external rotation for BPBI.
• The procedure is associated with a high rate of reoperation.
• Further research is needed to optimize surgical techniques and patient selection.