Scientific Articles   |    
Combined Glenoid Anteversion Osteotomy and Tendon Transfers for Brachial Plexus Birth Palsy
Emily Dodwell, MD, MPH, FRCSC1; Sevan Hopyan, MD, PhD, FRCSC2
1 Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021. E-mail address: dodwelle@hss.edu
2 Division of Orthopaedic Surgery, Hospital for Sick Children, Room S107, 555 University Avenue, Toronto, ON M5G 1X8, Canada. E-mail address: sevan.hopyan@sickkids.ca
View Disclosures and Other Information
  • Disclosure statement for author(s): PDF

Based on an original article: J Bone Joint Surg Am. 2012 Dec 5;94(23):2145-52

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2012 Dec 12;2(4):e23 1-13. doi: 10.2106/JBJS.ST.L.00021
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case



Combined glenoid osteotomy with tendon transfers is a new alternative procedure for patients with severe glenohumeral dysplasia secondary to brachial plexus birth palsy.

Step 1: MRI or CT for Preoperative Planning

Use axial plane MRI or CT for preoperative planning.

Step 2: Surgical Approach with Deltoid Elevation

Position the patient laterally, and undertake a posterior approach, including lateral elevation of the deltoid origin.

Step 3: Subscapularis Slide

Elevate the subscapularis from the scapula, provisionally reduce the humeral head, and apply gentle external rotation.

Step 4: Harvest of the Teres Major and Latissimus Dorsi Tendons

Incise the insertions of the teres major and latissimus dorsi from the proximal part of the humerus and perform a tenolysis.

Step 5: Posterior Approach to the Glenohumeral Joint

Open the posterior glenohumeral joint and assess overhead elevation.

Step 6: Assessment and Improvement of Abduction Contracture

Improve abduction contracture if it is marked.

Step 7: Harvest of Bone Graft

Harvest tricortical graft from the scapular spine or posterior aspect of the acromion.

Step 8: Scapular Neck Osteotomy

Undertake a posterior opening wedge osteotomy of the scapular neck.

Step 9: Posterior Opening Wedge at the Osteotomy Site

Insert the bone graft into the osteotomy site.

Step 10: Joint Closure and Infraspinatus Repair

Close the posterior aspect of the capsule and the infraspinatus.

Step 11: Transfer of the Teres Major and Latissimus Dorsi

Transfer the teres major and latissimus dorsi tendons into an osseous trough at the greater tuberosity.

Step 12: Closure and Immobilization

Repair the deltoid, close the wound in layers, and apply a shoulder spica cast.

Step 13: Postoperative Plan

Maintain the spica cast for five to six weeks; then initiate physiotherapy.


In our series of thirty-two patients with severe glenohumeral dysplasia who underwent combined glenoid osteotomy and tendon transfers, early results suggest that the outcomes of this procedure are similar to those of proximal humeral external rotation osteotomy1.

What to Watch For



Pitfalls & Challenges

Figures in this Article

    First Page Preview

    View Large
    First page PDF preview
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS Essential Surgical Techniques?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    Provided by:
    Essential Surgical Techniques
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    District of Columbia (DC) - Children's National Medical Center
    New York - Icahn School of Medicine at Mount Sinai
    S. Carolina - Department of Orthopaedic Surgery Medical Univerity of South Carlonina
    W. Virginia - Charleston Area Medical Center