Modified technique of trapezius transfer to improve function in brachial plexus palsy

Objective Increase of shoulder stability. Elimination of inferior subluxation of the humeral head. Increase of active abduction. Better control of the paralyzed arm. Decrease or elimination of shoulder pain. Indications Palsy of deltoid and supraspinatus muscles with weak abduction, multidirectional shoulder instability and subluxation of the humeral head after complete neurosurgical therapy ( neurolysis, reconstruction of the brachial plexus). No essential active function of the elbow and hand. Contraindications Weakness of trapezius muscle. Incomplete rehabilitation after neurosurgical procedure. Stiffness of the glenohumeral joint. Arthritis of the glenohumeral joint. Surgical Technique The cranial part of the trapezius muscle is detached from the scapular spine and the clavicle. Its insertion at the acromion is left untouched. The acromion is freed from the scapular spine and the lateral end of the clavicle by oblique osteotomies and then transferred to the proximal humerus. Under maximum tension the deltoid muscle is sutured on top of the trapezius muscle. Postoperative Management Immobilization of the arm in an abduction support ( 75 of abduction) for 6 weeks. The physiotherapy program starts on the 1st postoperative day with assisted and active training of elbow, hand, and fingers. During the 1st postoperative week, the abduction support is removed for physiotherapy, abduction is maintained during the exercises. After 6 weeks, progressive adduction to remove the abduction support is commenced. Results The procedure was performed in 104 cases. 80 patients were followed up on average after 2.4 years (0.8-8 years). In all cases, the transfer resulted in an increase of function and in 95% in a decrease of multidirectional shoulder instability. The modification of the original technique in the latest 22 cases was superior in terms of shoulder stability. In all these cases, a decrease of instability was achieved and inferior subluxation was abolished.