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Adult brachial plexus injury is characterized by many complex problems and remains a dilemma to a reconstructive micro-surgeon. The majority of reported papers focus to improve or restore shoulder abduction. Attempts to improve external rotation through tendon transfer has been reported earlier only in the pediatric population. Recently, a novel technique of lower trapezius transfer to improve shoulder external rotation in the adult patients with brachial plexus injury has been reported with encouraging results. Objective: First, we aimed to compare the shoulder external rotation improvement through the lower trapezius transfer. Second, we evaluated the increase in shoulder and elbow joint motion, the transfer impact related to life quality, and muscle strength. Materials and Methods: At our institution, between 2011 and 2013, 10 lower trapezius transfers were performed. All patients were evaluated by means of Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and shoulder and elbow arc of movement goniometry, and they were classified according to Mallet (evaluation of function and arm appearance) and Lovett Scale (muscle strength grading). Results: Mean follow-up time was 6 months. There was a significant improvement in shoulder active flexion ( P = .046) and abduction ( P = .026), and external rotation improvement of 17° on active motion and 14° on passive one. In terms of shoulder abduction, the mean upsurge was 13° to active motion and 14° to passive. DASH score showed statistically significant improvement ( P = .008). Discussion and Conclusion: The main indication of lower trapezius transfer is the complete loss of shoulder external rotation in patients with brachial plexus or other neurologic injuries. This study showed an improvement in shoulder flexion and abduction, which have an impact on life quality measured by DASH score. Having seen that, we strongly believe that lower trapezius transfers could be performed to improve the shoulder stability and as a consequence, improve patient’s life quality.

Lower Trapezius Transfer to Improve External Shoulder Rotation in Patients With Brachial Plexus Injury