Stability of reconstructed paralyzed shoulders using a reflected long headbiceps technique

A new tendon transfer technique is proposed for the reconstruction of the p aralyzed shoulders secondary to Brachial Plexus Injury (BPI). In this tendo n transfer, the long head of the biceps tendons is utilized as a bridging t endon graft. It is reflected at the exit of the bicipital groove, passed th rough the deltoid and directed to the trapezius. The technique is referred to here as the Reflected Long Head Biceps (RLHB) technique. This study eval uated the effect of this tendon transfer on the anterior, posterior, and in ferior stability of the reconstructed should using cadaveric specimens. It was shown that loading of the RLHB contributed significantly to anterior st ability of the reconstructed shoulder for 90 deg elevation in the scapula p lane. The mean displacement was reduced by 56 percent with RLHB loaded (p<0 .01), by 56 percent with the rotator cuff loaded (p <0.005), and by 67 perc ent with both the RLHB and the rotator cuff loaded (p<0.004). For the post- operation conditions, variation of the directions of RLHB had no significan t effect on joint displacement in response to anterior loading. The RLHB te ndon also contributed to the posterior and inferior stability for the low a nd middle elevations in the plane of scapula. Two variations of the RLHB te ndon transfer procedures, namely the "Sub-Deltoid" and the "Through-Deltoid " techniques , were introduced and studied. These two techniques did not se em to have significantly different effects on the displacement of the humer al head in response to both posterior and inferior loading. The results of this study seemed to support the clinical feasibility of this tendon transf er approach as far as the biomedical stability of the reconstruction is con cerned.