Wednesday, August 10, 2022

Muscle Tendon Transfers Around the Shoulder

The function of the shoulder can be seriously impaired by conditions such as serratus anterior and trapezius muscle palsy, irreparable subscapularis tears, irreparable posterosuperior rotator cuff tears, and deltoid deficiency. The authors of Muscle Tendon Transfers Around the Shoulder Diagnosis, Treatment, Surgical Techniques, and Outcomes share their expertise, experience and outcomes in managing these disorders with muscle tendon transfers.

Their principles of muscle tendon transfers include 

1. the transferred muscle must be expendable, 

2. the muscle tendon unit needs to have similar excursion, 

3. the line of pull of the transferred tendon and of the recipient muscle should be similar in terms of biomechanical force

4. the transferred muscle should replace at least 1 grade of strength of the deficient recipient muscle.

5. candidate patients must have exhausted all nonoperative management, have preserved

passive range of motion, and have an understanding of the postoperative expectations and potential complications.

For patients with scapulothoracic abnormal motion due to long thoracic nerve palsy, the indirect or direct pectoralis major tendon transfer can reduce pain and improve active forward elevation.

For patients with scapulothoracic abnormal motion due to spinal accessory nerve palsy, the Eden-Lange or the triple tendon transfer procedures can reduce pain and improve active forward elevation and abduction as well as patient-reported clinical outcomes.

For patients with isolated irreparable subscapularis deficiency without anterosuperior humeral head escape both pectoralis major and latissimus dorsi transfer procedures can improve pain, forward elevation, and patient-reported outcomes.

For irreparable posterosuperior rotator cuff tears, forward elevation, abduction, and external rotation range of motion latissimus dorsi or lower trapezius tendon transfer procedures can improve patient-reported outcomes

For deficits in active external rotation, latissimus dorsi transfer with or without teres major transfer can restore active external rotation, both in the native shoulder and in the setting of reverse shoulder arthroplasty.

Complications of muscle tendon transfers. include infection, hematoma, and failure of tendon transfer healing.

The authors recommend that these complex procedures be performed by shoulder surgeons with appropriate training.

Comment: This article provides the most comprehensive information on indications, techniques and outcomes of muscle tendon transfers. It should be studied in detail by surgeons considering these approaches.

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).