[Modified technique of trapezius transfer to improve function in brachial plexus palsy].
OBJECTIVE
Increase of shoulder stability. Elimination of inferior subluxation of the humeral head. Increase of active abduction. Better control of the paralyzed arm. Decrease or elimination of shoulder pain.


METHODS
Palsy of deltoid and supraspinatus muscles with weak abduction, multidirectional shoulder instability and subluxation of the humeral head after complete neurosurgical therapy (neurolysis, reconstruction of the brachial plexus). No essential active function of the elbow and hand.


METHODS
Weakness of trapezius muscle. Incomplete rehabilitation after neurosurgical procedure. Stiffness of the glenohumeral joint. Arthritis of the glenohumeral joint.


METHODS
The cranial part of the trapezius muscle is detached from the scapular spine and the clavicle. Its insertion at the acromion is left untouched. The acromion is freed from the scapular spine and the lateral end of the clavicle by oblique osteotomies and then transferred to the proximal humerus. Under maximum tension the deltoid muscle is sutured on top of the trapezius muscle.


METHODS
Immobilization of the arm in an abduction support (75 degrees of abduction) for 6 weeks. The physiotherapy program starts on the 1st postoperative day with assisted and active training of elbow, hand, and fingers. During the 1st postoperative week, the abduction support is removed for physiotherapy, abduction is maintained during the exercises. After 6 weeks, progressive adduction to remove the abduction support is commenced.


RESULTS
The procedure was performed in 104 cases. 80 patients were followed up on average after 2.4 years (0.8-8 years). In all cases, the transfer resulted in an increase of function and in 95% in a decrease of multidirectional shoulder instability. The modification of the original technique in the latest 22 cases was superior in terms of shoulder stability. In all these cases, a decrease of instability was achieved and inferior subluxation was abolished.
Rühmann
Oliver
O
Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Agnes-Karll-Krankenhaus Laatzen/Klinikum Region Hannover, Hildesheimer Strasse 158, Laatzen. oliver.ruehmann@krh.eu
Kohn
Dieter
D
Bohnsack
Michael
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D020516:Brachial Plexus Neuropathies / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007103:Immobilization; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D010243:Paralysis / Q000601:surgery*; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D019651:Plastic Surgery Procedures; D012785:Shoulder Joint / Q000601:surgery; D020069:Shoulder Pain / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome