gms | German Medical Science

Objectives/Interrogation: Upper or complete brachial plexus lesions can lead to a severe weakness of the shoulder muscles. Following the denervation and atrophy of these muscles, the maximum range of motion, especially abduction, is impaired. Inferior subluxation of the humerus head in the resting position of the shoulder develops consequently, leading to a flail shoulder. Unfortunately, there are limited therapeutic options to improve this condition. We have developed a surgical procedure for the re-suspension of the humerus head to the acromion, and this study aims to evaluate the efficacy of this method retrospectively.

Methods: Between 2008 and 2014, 13 patients suffering from a paralysed upper limb and, consequently, flail shoulder were treated with this procedure. The humerus head was re-suspended from the acromion using an artificial ligament. In 6 patients, an additional supraspinatus to trapezius muscle-tendon transfer was performed due to complete supraspinatus wasting. The mean age was 30 years (±11) and the mean follow-up was 36 months (±14). All patients were male, and the right side was affected in 85%. The grade of subluxation was determined by measurement of the distance between the lower border of the acromion and the upper border of the humerus head clinically. Abduction was measured as the maximum possible thoraco-humeral angle using a goniometer, with the patient standing upright in front of the investigator. Pain was measured using a visual analogue scale. Furthermore, the ASES, the UCLA, and the Simple Shoulder Scores were obtained postoperatively.

Results and Conclusions: Abduction was improved from 11° (±18) preoperatively to 54° (±17) postoperatively, p<0.05. Pain was reduced from 3.3 (± 3.8) preoperatively to 1.7 (± 2.8) postoperatively, p<0.05. The grade of subluxation was improved from 3.9 cm (±0.6) preoperatively to 0.5 cm (±1.2) postoperatively, p<0.05. The mean postoperative ASES, Simple Shoulder and UCLA Shoulder Score were 60.8 (±13.7), 2.6 (±0.9), and 18.2 (±3.6), respectively. All patients reported a highly satisfying stability of their shoulder. No foreign-body reactions or wound healing disorders occurred.

In this article, we present a novel procedure to suspend the humerus head from the acromion in the case of inferior subluxation of the humerus head. Subluxation can be reduced with this procedure, and existing muscle strength can be used exclusively for movement. Restoring dynamic shoulder stability can treat the pain arising from a flail shoulder as well.