Transfer of upper trapezius with clavicular segment for restoration of shoulder movements following injury to the brachial plexus

Abstract

Aim: Most brachial plexus palsies occur following high-velocity trauma. The shoulder joint is a large proximal joint which influences the motion of the hand. Transfer of the trapezius muscle is an effective alternative for palsy of the deltoid and supraspinatus muscles. Methods: Between 2009 and 2014, 32 patients were treated with modified trapezius muscle transfer in which only the descending fibers along with their attachment to the lateral third of clavicle were used. The clavicle was fixed to the anterolateral surface of the humerus by cancellous screws. The arm was immobilized for 6 weeks. Results: All the 32 patients had improved function with stability of the shoulder. The average increase in active abduction was from 7.5° (range: 0°-30°) to 85° (range: 45°-140°), and the mean forward flexion increased from 5.63° (range: 0°-15°) to 55.2° (range: 40°-90°) after a mean follow-up of 8.25 months. Twenty-four of the 32 patients rated the result as good to excellent and were satisfied with the improvement in stability and function. Fifty nine point thirty eight percent patients had Medical Research Council Muscle power 4 after the surgery. Conclusion: Transfer of the upper trapezius muscle with a segment of the clavicle segment for a flail shoulder can provide satisfactory function and stability with fewer complications.