Reconstructive operations for the paralyzed shoulder in brachial plexus palsy: concept of treatment

Sixty-three patients with persistent brachial plexus palsy underwent a tran sfer of the trapezius muscle and 14 patients a shoulder arthrodesis. Thirte en female and 64 male patients were treated with a mean age of 31 yr (17-69 yr). The average follow-up period was 14 months (6-50 months). In all case s, the trapezius transfer resulted in increased abduction from 6.1 degrees to an average of 36.4 degrees (20-80 degrees) and forward flexion from 13.8 degrees to an average of 31.9 degrees (10-90 degrees). The multidirectiona l shoulder instability was improved in 60 patients. Strength and functional improvement was, on average, greater following shoulder arthrodesis (abduc tion from 9.6 to 59.3 degrees (40-90 degrees), forward flexion from 11.4 to 50.7 degrees (30-90 degrees)). In patients with brachial plexus palsy, tra pezius transfer resulted in an improvement of shoulder function and stabili ty as well as subjectively. The increase in function was, however, less pro nounced in comparison with shoulder arthrodesis. The advantages of the tran sfer are the regaining of normal passive function and the shorter duration of surgery. Shoulder fusion is more suitable for those patients who require the best possible extent of function and strength in the shoulder. (C) 199 9 Elsevier Science Ltd. All rights reserved.