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[Modified technique of trapezius transfer to improve function in brachial plexus palsy].
Oper Orthop Traumatol 2008; 20(1):25-37OO

Abstract

OBJECTIVE

Increase of shoulder stability. Elimination of inferior subluxation of the humeral head. Increase of active abduction. Better control of the paralyzed arm. Decrease or elimination of shoulder pain.

INDICATIONS

Palsy of deltoid and supraspinatus muscles with weak abduction, multidirectional shoulder instability and subluxation of the humeral head after complete neurosurgical therapy (neurolysis, reconstruction of the brachial plexus). No essential active function of the elbow and hand.

CONTRAINDICATIONS

Weakness of trapezius muscle. Incomplete rehabilitation after neurosurgical procedure. Stiffness of the glenohumeral joint. Arthritis of the glenohumeral joint.

SURGICAL TECHNIQUE

The cranial part of the trapezius muscle is detached from the scapular spine and the clavicle. Its insertion at the acromion is left untouched. The acromion is freed from the scapular spine and the lateral end of the clavicle by oblique osteotomies and then transferred to the proximal humerus. Under maximum tension the deltoid muscle is sutured on top of the trapezius muscle.

POSTOPERATIVE MANAGEMENT

Immobilization of the arm in an abduction support (75 degrees of abduction) for 6 weeks. The physiotherapy program starts on the 1st postoperative day with assisted and active training of elbow, hand, and fingers. During the 1st postoperative week, the abduction support is removed for physiotherapy, abduction is maintained during the exercises. After 6 weeks, progressive adduction to remove the abduction support is commenced.

RESULTS

The procedure was performed in 104 cases. 80 patients were followed up on average after 2.4 years (0.8-8 years). In all cases, the transfer resulted in an increase of function and in 95% in a decrease of multidirectional shoulder instability. The modification of the original technique in the latest 22 cases was superior in terms of shoulder stability. In all these cases, a decrease of instability was achieved and inferior subluxation was abolished.

Authors+Show Affiliations

Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Agnes-Karll-Krankenhaus Laatzen/Klinikum Region Hannover, Hildesheimer Strasse 158, Laatzen. oliver.ruehmann@krh.euNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
English Abstract
Journal Article

Language

ger

PubMed ID

18338116

Citation

Rühmann, Oliver, et al. "[Modified Technique of Trapezius Transfer to Improve Function in Brachial Plexus Palsy]." Operative Orthopadie Und Traumatologie, vol. 20, no. 1, 2008, pp. 25-37.
Rühmann O, Kohn D, Bohnsack M. [Modified technique of trapezius transfer to improve function in brachial plexus palsy]. Oper Orthop Traumatol. 2008;20(1):25-37.
Rühmann, O., Kohn, D., & Bohnsack, M. (2008). [Modified technique of trapezius transfer to improve function in brachial plexus palsy]. Operative Orthopadie Und Traumatologie, 20(1), pp. 25-37. doi:10.1007/s00064-008-1225-y.
Rühmann O, Kohn D, Bohnsack M. [Modified Technique of Trapezius Transfer to Improve Function in Brachial Plexus Palsy]. Oper Orthop Traumatol. 2008;20(1):25-37. PubMed PMID: 18338116.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Modified technique of trapezius transfer to improve function in brachial plexus palsy]. AU - Rühmann,Oliver, AU - Kohn,Dieter, AU - Bohnsack,Michael, PY - 2008/3/14/pubmed PY - 2008/4/29/medline PY - 2008/3/14/entrez SP - 25 EP - 37 JF - Operative Orthopadie und Traumatologie JO - Oper Orthop Traumatol VL - 20 IS - 1 N2 - OBJECTIVE: Increase of shoulder stability. Elimination of inferior subluxation of the humeral head. Increase of active abduction. Better control of the paralyzed arm. Decrease or elimination of shoulder pain. INDICATIONS: Palsy of deltoid and supraspinatus muscles with weak abduction, multidirectional shoulder instability and subluxation of the humeral head after complete neurosurgical therapy (neurolysis, reconstruction of the brachial plexus). No essential active function of the elbow and hand. CONTRAINDICATIONS: Weakness of trapezius muscle. Incomplete rehabilitation after neurosurgical procedure. Stiffness of the glenohumeral joint. Arthritis of the glenohumeral joint. SURGICAL TECHNIQUE: The cranial part of the trapezius muscle is detached from the scapular spine and the clavicle. Its insertion at the acromion is left untouched. The acromion is freed from the scapular spine and the lateral end of the clavicle by oblique osteotomies and then transferred to the proximal humerus. Under maximum tension the deltoid muscle is sutured on top of the trapezius muscle. POSTOPERATIVE MANAGEMENT: Immobilization of the arm in an abduction support (75 degrees of abduction) for 6 weeks. The physiotherapy program starts on the 1st postoperative day with assisted and active training of elbow, hand, and fingers. During the 1st postoperative week, the abduction support is removed for physiotherapy, abduction is maintained during the exercises. After 6 weeks, progressive adduction to remove the abduction support is commenced. RESULTS: The procedure was performed in 104 cases. 80 patients were followed up on average after 2.4 years (0.8-8 years). In all cases, the transfer resulted in an increase of function and in 95% in a decrease of multidirectional shoulder instability. The modification of the original technique in the latest 22 cases was superior in terms of shoulder stability. In all these cases, a decrease of instability was achieved and inferior subluxation was abolished. SN - 0934-6694 UR - https://www.unboundmedicine.com/medline/citation/18338116/[Modified_technique_of_trapezius_transfer_to_improve_function_in_brachial_plexus_palsy]_ L2 - https://doi.org/10.1007/s00064-008-1225-y DB - PRIME DP - Unbound Medicine ER -