Teres Major Transfer Research Articles

Results of Latissimus Dorsi and Teres Major Transfer to the Rotator Cuff in the Treatment of Erb's Palsy

A retrospective study of the results of latissimus dorsi and teres major transfer in the treatment of Erb's palsy was conducted in 10 patients. All patients underwent release of the pectoralis major and transfer of the latissimus dorsi and teres major tendons to the rotator cuff at a mean age of 7 years and 2 months. Range of motion, patient satisfaction, and presence of any complications were evaluated postoperatively at a mean of 3 years. Active shoulder abduction improved from a mean of 72 degrees preoperatively to 136 degrees postoperatively. Postoperative shoulder active external rotation averaged 64 degrees. Subjectively, all patients participating in a questionnaire thought use of the operated-on extremity had improved since surgery. All but one patient were satisfied with the final outcome. Complications included one hypertrophic scar. Transfer of the latissimus dorsi and teres major to the rotator cuff in treatment of persistent Erb's palsy improves shoulder abduction and external rotation and results in a high degree of patient satisfaction.

Functional outcome after the L'Episcopo procedure

A study was undertaken to assess functional outcome in 11 patients undergoing latissimus dorsi and teres major transfer (L'Episcopo procedure) for external rotation deficient shoulders. The mean age was 37 years (range 18 to 48 years). All of the patients had adult-onset brachial plexus injuries. The mean time for injury to operation was 32 months. Patients were evaluated by questionnaire, measurement of the range of motion, strength testing, and an overhead work simulation. Of the patients studied, 10 of the 11 patients were working (8 returned to their preinjury employment). The cumulative postoperative mean activities of daily living score was 20 (maximum possible 33) compared with 14 before surgery. No complications occurred. Ten patients reported confidence in the limb and believed the procedure was worthwhile. Mean active external rotation of the shoulder at 0° and 90° elevation was 28° (range 15° to 55° and 36° (range 0° to 90°), respectively. Postoperative external rotation strength was 0.32 that of the control side with the arm at the side. Seven of the nine patients tested were able to complete the Valpar overhead work simulation. The L'Episcopo muscle-tendon transfer reliably improves functional outcome in the late functional reconstruction of adult-onset brachial plexus lesions.

Latissimus dorsi and teres major transfer to rotator cuff for Erb's palsy

During a 20-year period the authors operated on 56 patients with Erb's palsy to create active external rotation of the shoulder. Thirty-five patients had a follow-up period longer than 2 years (average 5 years), which allowed comparison with preoperative motion and strength. Preoperative passive external rotation averaged 5 degrees, whereas active abduction averaged 74 degrees. Preoperative external rotation strength was less than grade 2, whereas preoperative abduction strength was grade 2 or 3 in 33 of the 35 patients. Postoperative active external rotation averaged 31 degrees with only two recurrent internal rotation contractures. Postoperative active abduction averaged 120 degrees. Postoperative strength in external rotation increased in 29 of the 35 patients, with abduction strength increasing one or more grades in 13 of the 35 patients. Four complications occurred. Three patients continued to lose external rotation and required further surgical procedures, and a fourth had a superficial infection. This procedure compares well with the classic transfers to the proximal humerus in that it provides active external rotation in most cases and in some increases shoulder abduction strength.

Latissimus Dorsi and Teres Major Transfer for the Treatment of Massive Rotator Cuff Tear

Latissimus Dorsi and Teres Major Transfer for the Treatment of Massive Rotator Cuff Tear

Modified Latissimus Dorsi and Teres Major Transfer for External Rotation Deficit of the Shoulder

Variable impairment occurs following birth associated brachial plexus injury. Muscle transpositions have evolved in response to patient need for functional reconstruction. Loss of external rotation limits the ability to perform activities with the arm in an overhead position. A modification of the combined latissimus dorsi and teres major transfer is described by means of which increased excursion of the transfer may be achieved.