Outcome of trapezius transfer to improve shoulder abduction in children with birth brachial plexus palsy
Keywords:
trapezius, birth brachial plexus palsy, adduction contracture, tendon transfer, soft tissue releaseAbstract
Background: Addition of a trapezius to deltoid transfer has been recommended by various authors in overcoming the deficit in shoulder abduction while correcting the deficit in external rotation of the shoulder in patients with birth brachial plexus palsy (BBPP). Literature analyzing the effect of trapezius transfer in patients with paralyzed deltoid stands limited. The purpose of our study is to report the outcome of trapezius transfer for improvement in shoulder abduction in patients with BBPP with weak deltoid function (motor power < grade 3) and to analyze the various preoperative factors that could potentially influence the outcome of the surgery.
Methods: 25 patients with a mean age of 11 years with limited shoulder abduction and deltoid power < grade 3, underwent trapezius transfer between 2013 and 2023. Pre-operative assessments included age, range of shoulder abduction, extent of involvement, Mallet score, and power of elbow flexion. Post-operative range of shoulder abduction and Mallet score were noted. These patients were followed up for a minimum of 1 year (range, 12–60 months).
Results: Average shoulder abduction improved from 48_ to 100_ (range: 40_????147_). The mean improvement in shoulder abduction noted was 52 _ 12 degrees (p-value, <0.05). No statistically significant correlation was found between the improvement in shoulder abduction and the extent of neurological involvement, power of elbow flexion, and previous nerve surgery. However, a weak-to-moderate negative correlation was noted between the age at surgery and the improvement in shoulder abduction (Pearson’s r = ????0.4138). A moderate positive correlation between the outcome of trapezius transfer and the pre-operative abduction was also noted (Pearson coefficient of 0.5175).
Conclusion: Trapezius transfer is an effective method to improve shoulder abduction in patients with deltoid power less than grade 3. Younger children with better preoperative abduction tend to get superior results of trapezius transfer.
