Functional Reconstruction of the Shoulder by Multiple Muscle Transfer following Upper Brachial Plexus Paralysis

Abstract

Functional reconstruction by multiple muscle transfer achieves less shoulder joint stability than arthrodesis, but a far greater ROM can be obtained by functional reconstruction. We performed multiple muscle transfers for upper brachial plexus paralysis with sufficient donor muscle strength (5for trapezius,4 or more for the sternal head of pectoralis major, and 4 or more for any of latissimus dorsi, teres major, or serratus anterior) and in the absence of shoulder joint contracture. We wish to present our method and results here.
Subjects and methods: Five patients were operated on at our department from 1993 to 1996. All the patients were men, and their mean age was 21.8 years. The cause of upper brachial plexus paralysis was a motorcycle accident in all cases. We moved the sternal head of the pectoralis major to the distal clavicle for flexion reconstruction, attached the trapezius to the lateral aspect of the proximal humerus for abduction reconstruction, and attached one or more of the latissimus dorsi, the teres major, or the serratus anterior to the infraspinatus for reconstruction of external rotation. Range of motion (ROM) and muscle strength were measured before and after surgery while standing and while lying on a bed. The mean period from injury to operation was 24.2 months. The mean follow-up period was 51.6 months.
Results: The ROM for flexion, abduction, and external and internal rotation had improved significantly after surgery. The muscle strength for flexion, abduction, and external rotation was also significantly improved from 0 or 1 before surgery to 2 after surgery. Conclusions: Functional reconstuction of the shoulder by multiple muscle transfers was performed for upper brachial plexus paralysis and a good outcome was obtained.