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.