Secondary operations to restore function of the shoulder after brachial plexus lesion.

Introduction: The results of an integrated concept of therapy are presented including a description of indications and the various operative procedure s to compensate insufficient shoulder muscles following brachial plexus les ion. Patients and methods: To improve stability and function of the shoulde r in case of deltoid and supraspinatus paralysis 12 patients (1 female; 11 male; average age 29.4 years, range 17 to 56 years) underwent a shoulder ar throdesis. In 54 patients (11 female; 43 male; average age 30.3 years, rang e 18 to 69 years) a trapezius transfer was performed. The indication for a rotation osteotomy of the humerus to improve loss of external rotation due to paralytic infraspinatus muscle was determined in 4 male patients (averag e age 29.8 years, range 16 to 42 years). Our results are based upon an aver age follow-up of 2.0 (0.5-7.5) years after shoulder fusion, 1.9 (0.5-4.5) y ears after trapezius transfer and 1.6 (0.5-3.5) years after rotation osteot omy of the humerus. Results: The trapezius transfer resulted in increased f unction of abduction of 6.2 degrees to 37.1 degrees (5 degrees-80 degrees) and forward flexion of 15.1 degrees to 36.2 degrees (10 degrees-90 degrees) . A more stable condition of multidirectional shoulder instability was expe rienced by 50 patients (92.6%) and 49 patients (90.7%) were subjectively sa tisfied with the outcome of the operation. The strength and extent of funct ional improvement was, on average, greater following shoulder arthrodesis: abduction of 9.6 degrees to 65 degrees (40 degrees-90), forward flexion of 15.4 degrees to 59.2 degrees (30 degrees-90 degrees). 10 patients (83.3%) w ere subjectively satisfied with the outcome. Patients who had undergone ext ernal rotation osteotomy showed an average deficiency of external rotation of 20 degrees before operation. After osteotomy an improvement of 32.5 degr ees to 12.5 degrees external rotation was achieved. All patients were satis fied with the increase of function. Conclusions: In patients with brachial plexus palsy, secondary operations according to the individual pattern of p aralysis result in an improvement of shoulder function and stability as wel l as patients satisfaction.