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

OBJECTIVE: Patients with brachial plexus birth injuries (BPBIs) are at risk for limitations in shoulder external rotation. The role of lower trapezius tendon transfer restore shoulder external rotation in this population has been well characterized. This study aimed to evaluate utility of lower trapezius tendon transfer for restoration external rotation in a subset of pediatric patients.<br /> METHODS: Seventeen pediatric patients with were treated with lower trapezius tendon transfer restore external rotation of the shoulder. Mean surgery was 8 years, and 11 were female. Six patients prior shoulder surgery to restore external rotation, while had prior nerve surgery to restore shoulder function. of motion before lower trapezius transfer and at follow-up was obtained. Mean follow-up was 36 months.<br /> RESULTS: Active forward flexion did not significantly change from preoperative to final follow-up (mean, and 141 degrees; P = 0.46). External rotation in adduction icantly changed from preoperative to final follow-up 4 degrees and 26 degrees; P < 0.001). External rotation in abduction significantly changed from preoperative to final follow-up (mean, 75 degrees and 84 degrees; P = 0.048). Six patients (35%) subsequent surgeries at average 17 months from this cedure. Significant univariate associations with quent surgery included certain intraoperative concomitant procedures-coracoid osteotomy/excision (P = 0.02) biceps tenodesis (P = 0.04)-while bony glenoid augmentation/reconstruction tren ded toward significant association (P = 0.05). <br /> 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.