title: Outcome of triple-tendon transfer, an Eden-Lange variant, to reconstruct trapezius paralysis.
abstract: BACKGROUND
  This study describes the technique and evaluates the outcome of the triple-tendon (T3) transfer, an Eden-Lange variant, to the scapula to stabilize the scapulothoracic articulation in the treatment of symptomatic trapezius paralysis.
  
  
  METHODS
  T3 transfers were performed in 22 patients with a history of persistent trapezius paralysis secondary to spinal accessory nerve injury. The indications for surgery included shoulder pain and weakness and limited range of motion of the shoulder. The T3 transfer included transfer of the levator scapulae to the lateral aspect of the spine of the scapula, the rhomboid minor to the spine of the scapula just medial to the levator scapulae insertion, and the rhomboid major to the medial spine of the scapula, including all muscles bony insertions.
  
  
  RESULTS
  At an average follow-up of 35 months, winging was corrected in all patients, with improvement of shoulder asymmetry. All patients had significant improvement of pain (P < .01) and range of motion, including active shoulder abduction that improved from an average of 71° preoperatively to 118° postoperatively (P < .02) and shoulder flexion from an average of 102° to 150° (P < .01). There were also significant improvements in aggregate Constant Shoulder Score (P < .01), subjective shoulder value (P < .01), and Disabilities of the Arm, Shoulder and Hand score (P < .01). All patients were very satisfied with the outcome of surgery.
  
  
  CONCLUSIONS
  This study shows that the T3 transfer is effective in stabilizing the scapulothoracic articulation and restoring the function of the trapezius, and thus, in improving pain and shoulder function in patients with symptomatic trapezius paralysis.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: elhassan.bassem@mayo.edu.
authors.forename: Bassem T
authors.initials: BT
authors.lastname: Elhassan
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Wagner
mesh_terms: D061227:Accessory Nerve Injuries / Q000601:surgery; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D012540:Scapula / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery*; D020069:Shoulder Pain / Q000503:physiopathology / Q000601:surgery*; D064171:Superficial Back Muscles / Q000294:innervation* / Q000503:physiopathology; D013709:Tendon Transfer / Q000379:methods*
keywords: Shoulder tendon transfer; trapezius paralysis