Keywords
tendon transfer
trapezius muscle
shoulder abduction
shoulder external rotation
nerve transfer
How to Cite
Abstract
Background. Brachial plexus injury (BPI) leads to severe dysfunction of the upper extremity (UE). Elbow flexion and multiaxial movements in glenohumeral joint (MGHJ) are prioritized in reconstruction strategy. Time-dependent (< 6 months) nerve transfers (NT) allow effective restoring of MGHJ. Late (> 6 months) reconstruction of MGHJ remains completely dependent on transfers of the functional tendon-muscle complexes.
Objective: to compare the outcomes of the classic Elhassan (c) and modified (m) transfer of the lower trapezius muscle (LTT) on recovery of monoaxial MGHJ.
Materials and Methods. Patient (P.) #3 with M4+ recovery of the deltoid muscle (DM) after NT and P. #4 without spontaneous recovery (SR) of DM – forward flexion (FF) was 170° and 0°, respectively, received cLTT. Patient #1 with M4+ recovery of DM after NT and P. #2 with M4+ SR of DM (FF was 160° and 50°, respectively), received mLTT – distal fixation point has been changed from the tendon of the infraspinatus to the tendon of supraspinatus muscle.
Results. Shoulder abduction (ABD) has been restored to 50° in P. #1 and P. #2, while the recovery of the external rotation (ER) has not been achieved – upper arm remained internally rotated (IR). ABD has been restored to 40° and 80° in P. #3 and P. #4; simultaneously +15° and +70° of ER has been restored.
Conclusions. The use of mLTT leads to more effective recovery of monoaxial MGHJ – ABD – 50° vs. 40° after cLTT. The use of cLTT leads to more effective recovery of another monoaxial MGHJ – ER – +15° and +70° vs. IR after mLTT; LTT should only be considered as a complementary surgical procedure, which utilization should cohere with a patient’s requirements to the MGHJ.
References
Chuang DC. Brachial plexus injury: nerve reconstruction and functioning muscle transplantation. Semin Plast Surg. 2010;24(1):57-66. doi: 10.1055/s-0030-1253242.
Siqueira MG, Martins RS. Surgical treatment of adult traumatic brachial plexus injuries: an overview. Arq Neuropsiquiatr. 2011;69(3):528-535. doi: 10.1590/s0004282x2011000400023.
Oatis, Carol A. Chapter 9: Mechanics and Pathomechanics of Muscle Activity at theShoulder Complex in Kinesiology: The Mechanics and Pathomechanics of Human Movement. 2nd ed. Baltimore, Lippincott Williams & Wilkins, 2009., pp.150-188.
Martin E, Senders JT, DiRisio AC, Smith TR, Broekman MLD. Timing of surgery in traumatic brachial plexus injury: a systematic review [published online ahead of print, 2018 May 1]. J Neurosurg. 2018;1-13. doi: 10.3171/2018.1.JNS172068. № 4. С. 121-127.
Strafun SS. Kliniko-elektromiohrafichni stadii denervatsiinoreinnervatsiinoho protsesu u miazakh kintsivok pry ushkodzhenni peryferychnykh nerviv. Travma. 2012. T. 13, № 4. S. 121-127.
Chuang DC. Brachial plexus injury: nerve reconstruction and functioning muscle transplantation. Semin Plast Surg. 2010 Feb;24(1):57-66. doi: 10.1055/s-0030-1253242. PMID: 21286305; PMCID: PMC2887004.
Moore AM (2014) Nerve transfers to restore upper extremity function: a paradigm shift. Front. Neurol.5:40. doi: 10.3389/fneur.2014.00040.
Domeshek LF, Novak CB, Patterson JMM, et al. Nerve Transfers-A Paradigm Shift in the Reconstructive Ladder. Plast Reconstr Surg Glob Open. 2019;7(6):e2290. Published 2019 Jun 25. doi: 10.1097/GOX.0000000000002290.
Bertelli JA, Ghizoni MF: Very distal sensory nerve transfers in high median nerve lesions. J Hand Surg Am. 2011, 36:387-93. doi: 10.1016/j.jhsa.2010.11.049.
Moore AM, Wagner IJ, Fox IK: Principles of nerve repair in complex wounds of the upper extremity. Semin Plast Surg. 2015, 29:40-7. doi: 10.1055/s-0035-1544169.
Patterson JMM, Russo SA, El-Haj M, Novak CB, Mackinnon SE. Radial Nerve Palsy: Nerve Transfer Versus Tendon Transfer to Restore Function. Hand (N Y). 2022 Nov;17(6):1082-1089. doi: 10.1177/1558944720988126. Epub 2021 Feb 3. PMID: 33530787; PMCID: PMC9608274.
Compton J, Owens J, Day M, Caldwell L. Systematic Review of Tendon Transfer Versus Nerve Transfer for the Restoration of Wrist Extension in Isolated Traumatic Radial Nerve Palsy. J Am Acad Orthop Surg Glob Res Rev. 2018 Apr 12;2(4):e001. doi: 10.5435/JAAOSGlobal-D-18-00001. PMID: 30211383; PMCID: PMC6132323.
Elhassan B. Lower trapezius transfer for shoulder external rotation in patients with paralytic shoulder. J Hand Surg Am. 2014 Mar;39(3):556-62. doi: 10.1016/j.jhsa.2013.12.016. PMID: 24559634.
Oatis, Carol A. Chapter 10: Analysis of the Forces on the Shoulder Complex during Activity in Kinesiology: The Mechanics and Pathomechanics of Human Movement. 2nd ed. Baltimore, Lippincott Williams & Wilkins, 2009., pp.188196.
Matthews WB. Aids to the examination of the peripheral nervous system. J Neurol Sci. 1977;33(1-2):299.
Standartizatsiya v neyrokhirurgii. Chast' 6. Vosstanovitel'naya i funktsional'naya neyrokhirurgiya. Pod red. akademika NAMN Ukrainy, prof. Ye. Pedachenko. Kiev: GU “INKh NAMNU”, 2020. 144 s.
Pshyk Ya. Anatomo-biomekhanichni osoblyvosti budovy plechovoho kompleksu ta vydy yoho poshkodzhennia. Moloda sportyvna nauka Ukrainy : zb. nauk. pr. z haluzi fiz. kultury ta sportu. L., 2009. Vyp. 13, t. 4. S. 144-149.
Chuang DCC, Ma HS. Current Concepts in the Management of Obstetrical Brachial Plexus Injuries: The Taipei Experience. Semin Plast Surg. 2004 Nov;18(4):309–17. doi: 10.1055/s2004-837257. PMCID: PMC2884801.
Gates DH, Walters LS, Cowley J, Wilken JM, Resnik L. Range of Motion Requirements for Upper-Limb Activities of Daily Living. Am J OccupTher. 2016;70(1):7001350010p17001350010p10. doi: 10.5014/ajot.2016.015487.
Hartzler RU, Barlow JD, An KN, Elhassan BT. Biomechanical effectiveness of different types of tendon transfers to the shoulder for external rotation. J Shoulder Elbow Surg. 2012 Oct;21(10):1370-6. doi: 10.1016/j.jse.2012.01.026. Epub 2012 May 8. PMID: 22572399.
Phillips D, Kosek P, Karduna A. The contribution of the supraspinatus muscle at sub-maximal contractions. J Biomech. 2018 Feb 8;68:65-69. doi: 10.1016/j.jbiomech.2017.12.015. Epub 2017 Dec 15. PMID: 29277261; PMCID: PMC5783756.
Vitikainen AM, Salli E, Lioumis P, Mäkelä JP, Metsähonkala L. Applicability of nTMS in locating the motor cortical representation areas in patients with epilepsy. Acta Neurochir (Wien). 2013 Mar;155(3):507-18. doi: 10.1007/ s00701-012-1609-5. Epub 2013 Jan 19. PMID: 23328919.
Park H, Choi JY, Yi Sh et al. Relationship between the moreaffected upper limb function and daily activity performance in children with cerebral palsy: a cross-sectional study. BMC Pediatr. 2021;21;459. doi: 10.1186/s12887-021-02927-2.
Lemmens RJ, Janssen-Potten YJ, Timmermans AA, Defesche A, Smeets RJ, Seelen HA. Arm hand skilled performance in cerebral palsy: activity preferences and their movement components. BMC Neurol. 2014;14:52. doi: 10.1186/1471-2377-14-52.
This work is licensed under a Creative Commons Attribution 4.0 International License.