gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Transfer of the trapezium muscle for external shoulder rotation gain in patients with brachial plexus injuries

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  • presenting/speaker Samuel Ribak - Puc Campinas University, Cotia, Brazil
  • Alexandre Tietzmann - Puc Campinas University, Cotia, Brazil
  • Helton Hirata - Puc Campinas University, Cotia, Brazil
  • Gustavo Mohr - Puc Campinas University, Cotia, Brazil
  • Mogar Dreon Gomes - Puc Campinas University, Cotia, Brazil

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1792

doi: 10.3205/19ifssh1141, urn:nbn:de:0183-19ifssh11419

Published: February 6, 2020

© 2020 Ribak et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Introduction: In brachial plexus injuries after complete neurological treatment (neurolysis, grafting, nerve transfers) and adequate physiotherapy, secondary surgery may still be required to improve shoulder stability and function The external rotation of the shoulder is essential for daily functions, as it allows the patient to properly position the hand in the coronal plane of his body. The weakness of external rotation in the brachial plexus lesions keeps the upper limb in a vicious position of internal rotation and generates functional limitation in the simple daily activities

Objective: To analyze the results of the surgical technique of transfer the trapezius muscle to obtain external rotation of the shoulder. It aims to evaluate the stability of the shoulder as an adjunct effect.

Is it really effective?

Methods: Prospective study between June 2013 and December 2016. The technique of trapezius muscle transfer was performed in patients with brachial plexus injury, with deficit in stability and external rotation of the shoulder, with time lapse longer than 12 months of the accident or cases where there was no recovery (total or partial) after repair surgeries or nerve reconstruction. The casuistry consists of ten cases, all male, of traumatic origin, coming from motorcycle accidents. The mean age was 23.8 years (18 to 28), with average time between the accident and the muscle transfer of 20.8 months (13 to 30 months). Parameters such as shoulder movement arc, DASH score and degree of muscle strength were analyzed in the pre and postoperative periods.

Results and Conclusions: The gain of the external rotation was on average 30°, with statistical significance (p <0.05%). In all cases there was improvement in shoulder stability, improvement of pain and satisfaction with the procedure. The DASH scores had an initial mean of 67 points and a final score of 36 points.

In patients with chronic brachial plexus injury, the transfer of the trapezius muscle to obtain external rotation of the shoulder is effective and presents good clinical results. With this technique, good shoulder stability is obtained, providing an improvement in the quality of life of these patients.