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1. Versus 2. Tendon Transfer in Treatment of Brachial Plexus Birth Palsy
Xuyang Song, MD; Elie Miller, BA; Joshua M. Abzug, MD
University of Maryland, Baltimore, MD

Introduction: Tendon transfers (TT) are a common procedure utilized for brachial plexus birth palsy (BPBP) patients to improve shoulder function, specifically abduction and external rotation. The traditional use of two tendons in C5-7 patients may result in loss of midline function. Therefore, we assessed the outcomes of transferring a single tendon (1TT) versus the traditional method (2TT) for patients with C5-7 injuries.
Materials & Methods: A retrospective review of all BPBP patients that underwent tendon transfers over a 4 year period was performed at 2 institutions. All patients who had tendon transfer surgery and were C5-7 injuries were included. Outcomes were assessed utilizing the Modified Mallet (MM) scores and shoulder abduction range of motion.
Results: A retrospective review over a 4 year period identified 22 C5-7 patients, including 11 patients in both the 1TT and 2TT groups. The average age at surgery was 3.6 (1-5.4) years in the 1TT and 4.1(2.1-12.7) years in the 2TT group.
Pre-operative total MM score for the 1TT group was 14.6 and 15.1 for the 2TT group. The average MM internal rotation score was 3.55 for the 1TT group and 3.82 for 2TT group pre-operatively (p=0.19) and 2.73 and 2.64, respectively, post-operatively (p = 0.27).
When comparing pre and post-operative MM categories, there were significant improvements in both the 1TT and 2TT groups for global abduction (p<.05 and p<.01) and external rotation (p<0.00001 for both). MM hand to neck was significantly improved in the 2TT group (p<.05) but not in the 1TT group (p=.053). Internal rotation significantly decreased in both groups (p<0.001).
Final follow-up MM scores were 17.1 and 16.9 for the 1TT and 2TT groups, respectively (p=0.83). Both were significantly increased from the pre-operative MM values (P<0.01).
Conclusions: 1TT and 2TT procedures result in substantial gains in upper extremity functions for patients as measured by the MM score, specifically within the global abduction and external rotation subcategories, however a significant loss occurs in internal rotation for both groups. 1TT and 2TT procedures have similar outcomes however hand to neck was significantly improved only in the 2TT group and therefore one should balance the risks of multiple tendon transfers versus functional benefits.

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