Introduction: Shoulder instability and lack of shoulder mobility are common and exhausting problems in adult patients with traumatic brachial plexus injury. Although primary nerve reconstruction remains the “gold standard” for brachial plexus management, secondary shoulder reconstruction by trapezius transfer is needed in neglected cases.
Results: Different upper trapezius transfer techniques are described in detail, starting from the first report by Hoffa et al. up to Rühmann’s modification of Saha’s technique. Additionally, lower trapezius transfer by Elhassan’s technique is discussed to review differences in functional outcome gained by each technique.
Conclusion: Secondary shoulder reconstruction options still have their indications in cases of late presentation and failed nerve surgery. There is a wide spectrum of outcomes due to the variability of the extent of injury. Using the upper and lower trapezius for the possible restoration of abduction and external rotation as described by Elhassan et al. yielded a mean post-operative shoulder abduction and external rotation of approximately 50° and 20°, respectively. Rühmann’s modification of Saha’s technique (suturing the partially freed deltoid muscle under maximum tension on top of the trapezius as far medially as possible) showed improvement in the outcomes of stability and abduction recovery (34° mean post-operative shoulder abduction). Reference
Mahmoud Salama, Usama Farghaly Omar. Role of Trapezius Transfer for Shoulder Reconstruction in Adult Traumatic Brachial Plexus Injuries: Literature Review.
International Microsurgery Journal 2018;1(4):3. [ View Article]