Steindler and pectoralis major flexorplasty: a comparative analysis.
Previously published studies on transfers to restore elbow flexion have rarely compared the outcomes among different techniques. We found no comparison between the Steindler procedure and pectoralis major tendon transfer. This study compared functional outcomes after these two types of elbow flexorplasty performed in conjunction with shoulder arthrodesis for patients with brachial plexus injuries. The same examiner assessed 14 patients who underwent shoulder fusion and elbow flexorplasty. Five had a pectoralis major tendon transfer, and nine underwent a modified Steindler procedure. All patients had brachial plexus lesions that were irreparable or had not responded to neurolysis, repair, or grafting. Average follow-up time was 60 months (range, 12 months-10 years). All patients completed a questionnaire (pain, function) and underwent an objective assessment of range of motion, isometric strength, isotonic power, grip, and pinch strength. The BTE Work Simulator (Baltimore Therapeutic Equipment, Hanover, MD) was used for muscle strength testing. Improvement was noted in daily activities including dressing and bilateral activities and was reflected in a significant improvement over preoperative function. No differences (at p = .05 level of significance) were found in objective tests between the pectoralis major transfer and the Steindler groups. In the patient requiring stabilization of the shoulder and flexorplasty, the pectoralis major tendon transfer was at least equivalent to the modified Steindler flexorplasty in terms of range of motion, strength, and subjective measures.
Upper Extremity Reconstructive Service, St Michael's Hospital, Toronto, Ontario, Canada.
D E
DE
Beaton
A
A
Dumont
M B
MB
Mackay
R R
RR
Richards
D000203:Activities of Daily Living; D000328:Adult; D001174:Arthrodesis; D001917:Brachial Plexus / Q000293:injuries* / Q000503:physiopathology; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D008297:Male; D010369:Pectoralis Muscles; D016059:Range of Motion, Articular / Q000502:physiology; D012782:Shoulder / Q000503:physiopathology; D000070599:Shoulder Injuries; D011795:Surveys and Questionnaires; D013709:Tendon Transfer / Q000379:methods*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000503:physiopathology / Q000601:surgery