We present a detailed description of our surgical technique and technical pearls of the muscle transfers to stabilize the shoulder, thereby reducing pain, and to restore shoulder motion, especially external rotation, in patients with brachial plexus injury.
Step 1: Preoperative Evaluation and Planning
Plan for potential tendon transfer with a detailed examination of the periscapular muscles to evaluate their availability and strength.
Step 2: Positioning, Preparation, and Draping
Make sure that the potential high-contact-pressure areas of the patient's body are well padded.
Step 3: Incision, Exposure, and Muscle Detachment
Plan to make the appropriate incision that allows full exposure of the shoulder muscles that will be used for transfer.
Step 4: Tendon Transfer
All muscles that will be used for transfer should be well exposed and dissected to obtain maximal excursion and to allow better transfer of the chosen muscles to different locations around the shoulder.
Step 5: Acromial Fixation and Deltoid Muscle Repair
The acromial attachment of the trapezius should be fixed distal to the greater tuberosity to improve the abduction/flexion moment arm.
Step 6: Postoperative Management and Rehabilitation
Stable immobilization of the shoulder for eight weeks followed by well-planned postoperative rehabilitation is needed to improve the outcome of shoulder reconstruction.
We reported our results in fifty-two patients who had been treated with this technique8.
What to Watch For
Pitfalls & Challenges