title: Trapezius muscle transfer for external shoulder rotation: anatomical study.
abstract: OBJECTIVE
  To compare the viability of transferring the lower and transverse trapezius to the greater tuberosity using three different techniques.
  
  
  METHODS
  Twelve shoulders from six cadavers were used. The primary outcome was to assess the suture viability of the trapezius muscle transfer to the greater tuberosity in the insertion topography of the infraspinatus, with the arm adducted during internal rotation (hand on the abdomen) and maximum scapular retraction. Three transfers were applied to each shoulder: the lower and transverse trapezius distal insertion (Group 1); lower trapezius alone (Group 2); and lower trapezius insertion and origin (Group 3). Accessory nerve integrity was assessed before and after transfers.
  
  
  RESULTS
  Sutures were viable in 42% (5/12) and 58% (7/12) on Groups 1 and 3, respectively, with no statistically significant difference (Fisher's test, p=0.558); Group 3 exhibited frequent neurologic injury (11/12). Group 2 was the least successful; the tendon did not reach the greater tuberosity, and no sutures were viable.
  
  
  CONCLUSIONS
  Groups 1 and 3 exhibited the best nongrafting suture viability to the greater tuberosity; however, Group 3 was associated to frequent spinal accessory nerve injury. Level of Evidence IV, Anatomical Study.
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Institute of Orthopedics and Traumatology, São Paulo, SP, Brazil, Institute of Orthopedics and Traumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Mauro Emilio Conforto
authors.initials: ME
authors.lastname: Gracitelli
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Institute of Orthopedics and Traumatology, São Paulo, SP, Brazil, Institute of Orthopedics and Traumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Jorge Henrique
authors.initials: JH
authors.lastname: Assunção
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Institute of Orthopedics and Traumatology, São Paulo, SP, Brazil, Institute of Orthopedics and Traumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Eduardo Angeli
authors.initials: EA
authors.lastname: Malavolta
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Institute of Orthopedics and Traumatology, São Paulo, SP, Brazil, Institute of Orthopedics and Traumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Daniel Takashi
authors.initials: DT
authors.lastname: Sakane
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Institute of Orthopedics and Traumatology, São Paulo, SP, Brazil, Institute of Orthopedics and Traumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Marcelo Rosa
authors.initials: MR
authors.lastname: de Rezende
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Institute of Orthopedics and Traumatology, São Paulo, SP, Brazil, Institute of Orthopedics and Traumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Arnaldo Amado
authors.initials: AA
authors.lastname: Ferreira Neto
keywords: Brachial plexus/injuiries; Paralysis; Shoulder; Tendon transfer