Restoration of Shoulder Abduction in Brachial Plexus Injury Muscle Tendon Reconstructions

Introduction: Author's Modification of Saha’s Procedure Author suggests transfer the both the Vertical as well Horizontal part of the Trapezius Muscle to the humerus to enhance the anterior, middle and posterior parts of the Deltoid muscle. Author has used vertical as well horizontal segment of the Trapezius Muscle in varying combinations in 32 patients with Global Brachial Plexus injury for restoration of shoulder abduction.

Methodology and Material: Through an inverted U incision extending along the anterior border of the clavicle, acromion and scapula Tr. Muscle is mobilized upwards from clavicle up to 10.0 CMS. Free Trapezius from the superior border of the remaining part of the scapular spine medially to the base of the spine where inferior fibers of the muscle glide over the triangular area of scapula 1.5 CMS OF Acromion is osteotomized along with the Tr. Muscle Osteo-synthesis is done at the greater tubercle using either tension band wire or Mitek Screw.

Using a longitudinal incision on the back for the vertical part of the trapezius muscle and by a careful blunt and sharp dissection ∼24 cm of the trapezius muscle was dissected. Use of vertical segment of the Trap. Muscle to enhance the posterior deltoid muscle function augments the overall shoulder control as well stability of Abduction

Using a U shaped incision on the shoulder extending along the anterior surface of clavicle, the acromion and the spine of scapula was used to harvest the transverse part of the trapezius muscle.

Take part of the bone along with the muscle attachment from the lateral end of the clavicle and / or the acromion process as suggested.

Gryphon BR technique for Soft Tissue / Bone anchoring

Preloaded with one or two strands of Ortho Cord Suture

Offering 55 lbs. of tensile strength.

Osteo-synthesis of the acromion done below the greater tubercle of the humerus using 3 strong Mitec sutures, with the arm kept abducted at 110° and flexed forward 20° to simulate the action of the middle fibers of the deltoid muscle function.

The vertical part of the dissected Trapezius muscle used to re-enforce the posterior fibers of the deltoid muscle function. The Trapezius muscle was slided for 7.0 cm.

Shoulder Abduction is maintained with a custom made adjustable splint at 90 - 1000.

Results: This is a follow up study of 22 patients, who achieved grade 3 - 4 abduction at the shoulder joint following the modified Saha/Bateman procedure. This action was further enhanced by the rotation of the scapula. Abduction up to 700 to 1100 could be achieved in most cases.

Conclusions: The mobility of the shoulder should be preserved with any or all possibilities of providing muscular control by means of multiple / tendon transfers. The Mayer’s transfer of the insertion of the Trapezius Muscle has been described as the most satisfactory transfer for complete paralysis of the Deltoid Muscle