Comparison of Latissimus Dorsi versus Teres Major Tendon Transfer to Restore External Rotation of the Shoulder in Patients with Erb Palsy.

Abstract

Background: The transfer of latissimus dorsi (LD) and teres major (TM) have been described for restoration of external rotation (ER) and shoulder abduction in neonatal brachial plexus palsy (NBPP). The aim of this prospective randomised study is to compare the outcomes of LD versus TM transfer in the treatment of internal rotation contracture of the shoulder in children with NBPP. Methods: The study was conducted from February 2014 to January 2018 and included NBPP patients with internal rotation contracture of the shoulder. Patients were randomised to either LD (Group 1) or TM (Group 2) tendon transfer. Patients were followed up for at least 38 months and assessed for improvements in the arc of shoulder abduction and ER. Results: The study included 30 patients with 15 patients randomised to each group respectively. Group 1 (n = 15) included 4 boys and 11 girls with a mean age of 2 years and 8 months (range: 1.5-5) and a mean follow-up of 62 months (range: 38-68). Group 2 (n = 15) included 6 boys and 9 girls with a mean age of 2 years and 6 months (range: 1.5-4.8) and a mean follow-up of 58 months (range: 38-68). All patients showed improvement in shoulder abduction and active and passive ER. There were no differences in shoulder abduction (p = 0.467), active ER (p = 0.124) and passive ER (p = 0.756) between both groups. Conclusions: Both LD and TM tendon transfers improved shoulder function in NBPP patients with internal rotation contracture of the shoulder. Level of Evidence: Level II (Therapeutic).