Lower Trapezius Tendon Transfer for Restoration of External Rotation in Brachial Plexus Birth Injury
Kareme D Alder1, Courtney E Baker1, Kyle E Robinson2
1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Lower trapezius tendon transfer improved shoulder external rotation in pediatric patients with brachial plexus birth injuries (BPBIs). However, the gains were not clinically significant, and reoperation rates were high.
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.
Objective:
Patients with brachial plexus birth injuries (BPBIs) are at risk for limitations in shoulder external rotation. The role of lower trapezius tendon transfer to restore shoulder external rotation in this population has not been well characterized. This study aimed to evaluate the utility of lower trapezius tendon transfer for restoration of external rotation in a subset of pediatric patients.
Methods:
Seventeen pediatric patients with BPBI were treated with lower trapezius tendon transfer to restore external rotation of the shoulder. Mean age at surgery was 8 years, and 11 were female. Six patients had prior shoulder surgery to restore external rotation, while 1 had prior nerve surgery to restore shoulder function. Range of motion before lower trapezius transfer and at latest follow-up was obtained. Mean follow-up was 36 months.
Results:
Active forward flexion did not significantly change from preoperative to final follow-up (mean, 147° and 141°; P = 0.46). External rotation in adduction significantly changed from preoperative to final follow-up (mean, 4° and 26°; P < 0.001). External rotation in abduction significantly changed from preoperative to final follow-up (mean, 75° and 84°; P = 0.048). Six patients (35%) had subsequent surgeries at average 17 months from this procedure. Significant univariate associations with subsequent surgery included certain intraoperative concomitant procedures-coracoid osteotomy/excision (P = 0.02) and biceps tenodesis (P = 0.04)-while bony glenoid augmentation/reconstruction trended toward significant association (P = 0.05).
Conclusions:
Lower trapezius tendon transfer for BPBI showed a statistically significant but unlikely clinically meaningful improvement in external rotation with a high rate of reoperation.
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