Reconstructive operations for the paralyzed shoulder in brachial plexus palsy: concept of treatment

• Published in: Injury Vol. 30; no. 9; pp. 609 - 618
• Main Authors: Rühmann, O, Gossé, F, Wirth, C.J, Schmolke, S
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-11-1999; Elsevier
• Subjects: Adolescent; Adult; Aged; Algorithms; Arthrodesis - methods; Biological and medical sciences; Brachial Plexus Neuropathies - surgery; Brachial plexus palsy; Female; Humans; Male; Medical sciences; Middle Aged; Orthopedic surgery; Reconstructive operation; Reconstructive Surgical Procedures - methods; Shoulder arthrodesis; Shoulder Joint - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Flaps; Trapezius transfer; Brachial plexus palsy; Shoulder arthrodesis; Trapezius transfer; Reconstructive operation; Human; Nervous system diseases; Prognosis; Motor system disorder; Indication; Surgical transfer; Anatomical reconstruction; Trapezius muscle; Orthopedic surgery; Treatment; Shoulder; Arthrodesis; Thoracic girdle; Upper limb; Peripheral nerve disease; Paralysis; Technique; Brachialis plexus syndrome
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/S0020-1383(99)00165-5

Sixty-three patients with persistent brachial plexus palsy underwent a transfer of the trapezius muscle and 14 patients a shoulder arthrodesis. Thirteen female and 64 male patients were treated with a mean age of 31 yr (17–69 yr). The average follow-up period was 14 months (6–50 months). In all cases, the trapezius transfer resulted in increased abduction from 6.1° to an average of 36.4° (20–80°) and forward flexion from 13.8° to an average of 31.9° (10–90°). The multidirectional shoulder instability was improved in 60 patients. Strength and functional improvement was, on average, greater following shoulder arthrodesis (abduction from 9.6 to 59.3° (40–90°), forward flexion from 11.4 to 50.7° (30–90°)). In patients with brachial plexus palsy, trapezius transfer resulted in an improvement of shoulder function and stability as well as subjectively. The increase in function was, however, less pronounced in comparison with shoulder arthrodesis. The advantages of the transfer are the regaining of normal passive function and the shorter duration of surgery. Shoulder fusion is more suitable for those patients who require the best possible extent of function and strength in the shoulder.