For a patient with total loss of shoulder control or in whom transfers are not possible, arthrodesis of the glenohumeral joint is the salvage procedure. The mobility of the shoulder should be preserved if there is any possibility of providing muscular control by means of multiple muscle transfers. Twenty five patients underwent functional reconstruction because of shoulder paralysis excluding those with birth palsy.
If a patient's C8 and Thl roots were in functional condition, and his latissimus dorsi and pectoralis major were also functional, the results of multiple muscle transfer surgery were successful. The trapezius, the levator scapulae and the latissimus dorsi were available for these operations.
Ten of the patients whose Thl roots only were in functional condition could flex the i r wrists and fingers. They could not, however, extend their wrists or fingers. Tendon transfer surgery on their hands was successful. When the trapezius and the levator scapulea were available for shoulder functional reconstruction, the results were satisfactory. They could adduct their shoulders by the pectoralis.
In paralysis involving a whole brachial plexus with avulsion of the roots, we attempted to restore elbow flexion using interconstal nerves. The results were successful. But in these cases, multiple muscle transfers were not successful due to a lack of available muscles. In three of the cases with a weak trapezius, arthrodesis of the glenohumeral joint was done. In six of the cases with a strong enough trapezius, the trapezius was transposed to the humerus. Even for patients with a whole brachial plexus injury, arthrodesis of the glenohumeral joint is not always indicated.
