The importance of restoring external rotation of the shoulder after brachial plexus injury (BPI) is well known. The first choice for shoulder function reconstruction is nerve transfer. However, some patients with poor recovery have difficulty in using their reconstructed limb. Moreover, there are patients who are not candidates for nerve transfer surgery due to chronicity or unavailability of a donor nerve. In such cases, the options for secondary procedures to improve shoulder function are often limited. We performed contralateral lower trapezius transfer (CLTT) to the infraspinatus in twelve patients in order to restore shoulder external rotation. All patients exhibited improvement in shoulder external rotation and disability of the arm, shoulder and hand (DASH) scores. No donor site deficit was noted in any patient. Two patients had rupture of the suture site at around four weeks after surgery. This study demonstrated that CLTT to the infraspinatus tendon is an effective procedure to improve shoulder external rotation in patients with BPI.
