title: Contralateral Trapezius Transfer to Restore Shoulder External Rotation Following Adult Brachial Plexus Injury.
abstract: OBJECTIVE
  To evaluate the outcome of contralateral lower trapezius origin transfer (CLTOT) to restore shoulder external rotation in patients with shoulder paralysis after brachial plexus injury (BPI).
  
  
  METHODS
  We evaluated 12 patients with a history of BPI with persistent shoulder paralysis. All patients had compromised ipsilateral lower trapezius muscle function. All patients underwent CLTOT prolonged with lumbar fascia to the affected infraspinatus tendon either isolated (7 patients) or as part of multiple tendon transfer (5 patients). Standardized patient outcomes measures were obtained.
  
  
  RESULTS
  At 23 months' follow-up, 10 patients had improved shoulder external rotation from no motion preoperatively to an average external rotation 110° from the abdomen. Five patients had marked improvement of pain, including 2 with isolated CLTOT and 3 with additional tendon transfers. Two patients experienced no change in pain. There were noted improvements in the Constant shoulder scores, simple shoulder value, and Disabilities of the Arm, Shoulder, and Hand scores. One patient sustained a fall resulting in stretch injury to the transfer, underwent successful revision surgery, and regained 100° active shoulder external rotation away from the abdomen more than a year after revision surgery. Another patient's transfer failed during rehabilitation but the patient elected not to pursue treatment. No patients had changes in contralateral shoulder motion or strength or any pain from the contralateral shoulder.
  
  
  CONCLUSIONS
  This study demonstrated that CLTOT to the infraspinatus tendon was effective in improving shoulder external rotation in patients with BPI.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopedics, Mayo Clinic, Rochester, MN. Electronic address: elhassan.bassem@mayo.edu.
authors.forename: Bassem T
authors.initials: BT
authors.lastname: Elhassan
authors.affiliation: Department of Orthopedics, Mayo Clinic, Rochester, MN.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Wagner
authors.affiliation: Department of Orthopedics, Mayo Clinic, Rochester, MN.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Spinner
authors.affiliation: Department of Orthopedics, Mayo Clinic, Rochester, MN.
authors.forename: Allen T
authors.initials: AT
authors.lastname: Bishop
authors.affiliation: Department of Orthopedics, Mayo Clinic, Rochester, MN.
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Shin
mesh_terms: D000328:Adult; D000367:Age Factors; D001917:Brachial Plexus / Q000293:injuries*; D020516:Brachial Plexus Neuropathies / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D013709:Tendon Transfer / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Contralateral trapezius tendon transfer; brachial plexus injury