Purpose
Evidence suggests that patients with brachial plexus birth injury are more likely
to retain midline function following a teres major tendon transfer without a concomitant
latissimus dorsi transfer. Both procedures increase shoulder external rotation and
abduction, but whether increased loss of midline frequency following double transfer
is due to glenohumeral (GH) joint motion or scapulothoracic (ST) compensation is unknown.
We hypothesized that double tendon transfers would exhibit greater GH external rotation
than single tendon transfers, thus requiring greater ST rotation to internally rotate
the shoulder, while GH and ST contributions to elevation remained equivalent between
both groups.
Methods
Twenty-six postsurgical children with C5/C6 brachial plexus birth injuries participated
in this study. Thirteen patients with single tendon transfers were matched with 13
with double tendon transfer. Coordinate systems of the thorax, scapula, and humerus
were measured utilizing motion capture in 6 arm positions. Joint angles were calculated
by the helical (ST) and modified globe method (GH and humerothoracic [HT]). Differences
between groups were compared with repeated measures of multivariate analyses of variance
for each position. Pending significant multivariate analyses of variance, univariate
analyses of variance determined joint differences between transfer groups.
Results
Joint rotations from neutral were similar between groups in 5 of 6 tested positions,
with double tendon transfers consistently demonstrating 15°–20˚ more internal rotation
at the GH and HT joints. Still, only the internal rotation position showed statistically
significant differences in GH and HT joint angles. The ST joint angles were similar
in this position (45.2˚ and 48.5˚).
Conclusions
The arc of motion for patients with double tendon transfer was more internally rotated
than in patients with single tendon transfer at the GH and HT joints for all positions.
However, both groups demonstrated little active rotation from neutral. Based on this
data, teres major-only tendon transfers may not reduce the risk of loss of midline
function.
Type of study/level of evidence
Therapeutic III.
Key words
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Article info
Publication history
Published online: September 03, 2021
Accepted:
June 18,
2021
Received:
January 4,
2021
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
