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Technique of Tendon Transfers About the Shoulder in Patients with Brachial Plexus Injury
Bassem Elhassan, MD1
1 Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address: elhassan.bassem@mayo.edu
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Based on an original article: J Bone Joint Surg Am. 2012 Aug 1;94(15):1391-8.

Disclosure: The author received no payments or services, either directly or indirectly (i.e., via his institution), from a third party in support of any aspect of this work. Neither the author nor his institution has 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, the author has not had any other relationships, or 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 Oct 10;2(4):e19 1-12. doi: 10.2106/JBJS.ST.L.00011
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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.

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    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.
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