Abstract
OBJECTIVE: To compare the viability of transferring the lower and transverse trapezius to the greater tuberosity using three different techniques. METHODS: Twelve shoulders from six cadavers were used. The primary outcome was to assess the suture viability of the trapezius muscle transfer to the greater tuberosity in the insertion topography of the infraspinatus, with the arm adducted during internal rotation (hand on the abdomen) and maximum scapular retraction. Three transfers were applied to each shoulder: the lower and transverse trapezius distal insertion (Group 1); lower trapezius alone (Group 2); and lower trapezius insertion and origin (Group 3). Accessory nerve integrity was assessed before and after transfers. RESULTS: Sutures were viable in 42% (5/12) and 58% (7/12) on Groups 1 and 3, respectively, with no statistically significant difference (Fisher's test, p=0.558); Group 3 exhibited frequent neurologic injury (11/12). Group 2 was the least successful; the tendon did not reach the greater tuberosity, and no sutures were viable. CONCLUSION: Groups 1 and 3 exhibited the best nongrafting suture viability to the greater tuberosity; however, Group 3 was associated to frequent spinal accessory nerve injury. Level of Evidence IV, Anatomical Study
Highlights
The external rotation of the shoulder is an essential movement to daily activities with upper limbs and its limitation causes major functional impairment.[1]
In the presence of subscapularis injuries, the transfer can lead to shoulder subluxation, pain and functional limitation; it is contraindicated as a single treatment.[7]
For the primary endpoint of the study, the feasibility or nor of the transfer, with the upper limb adducted and internally rotated, with the scapula at full retraction, we obtained in Group 1, the feasibility of suture in 42% of cases (5/12)
Summary
The external rotation of the shoulder is an essential movement to daily activities with upper limbs and its limitation causes major functional impairment.[1]. The action vector of the muscle is not similar to the infraspinatus and the gain of external rotation is limited.[4] In the presence of subscapularis injuries, the transfer can lead to shoulder subluxation, pain and functional limitation; it is contraindicated as a single treatment.[7] An alternative to the latissimus dorsi is the transfer of the lower trapezius, described for cases of obstetrics paralysis[8] and braquial plexus injuries.[9] The action vector of the lower portion of the trapezius is closest to the infraspinatus muscle and the results on gain of external rotation are promising.[8,10,11] its distal reach in the greater tuberosity has not been studied previously, and implies the need for tendon grafting and immobilization in abduction and external rotation.[9] The association of transferring the origin of the lower portion of the trapezoid could increase the distal reach of the insertion and has not been previously described in the literature. The aim of this study is to describe in cadavers the anatomic parameters and the feasibility of three techniques of trapeze transfer: lower portion together with the transverse, lower portion in isolation and double transfer of the lower portion (origin and insertion)
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