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Feasibility of Contralateral Trapezius Transfer to Restore Shoulder External Rotation: Part I
Eric Wagner, MD1; Bassem T. Elhassan, MD2
1Mayo Clinic, Rochester, MN; 2Orthopaedic Surgery, Div Hand Surgery, Mayo Clinic, Rochester, MN

Purpose: Loss of shoulder function, specifically external rotation, is very disabling in patients with brachial plexus injury. Although ipsilateral lower trapezius transfer has been shown to be effective in restoring shoulder external rotation, it may not be available in patients who have injury to the trapezius muscle or spinal accessory nerve transfer, significantly limiting the patient’s options. The purpose of this study is to evaluate the feasibility of contralateral trapezius transfer to restore shoulder external rotation.

Methods: The length of the lower trapezius and the distance necessary for contralateral trapezius transfer were measured on the surface in 20 volunteers and directly in 12 cadavers. The average distances between the medial spine of the scapula and T12(length of lower trapezius), and the greater tuberosities(distance for transfer) were measured with the scapula at neutral, maximally protracted, and maximally retracted. Then, in cadavers, the origin of the left lower trapezius was detached and transferred to the contralateral shoulder greater tuberosity. Pulling on the transferred muscle enabled us to determine the effectiveness in externally rotating the right shoulder and tension on the vascular pedicle.

Results: In the volunteers, the average difference between the length of the lower trapezius and the distance necessary for the transfer was 19mm with a 95%CI from 12mm to 26mm in neutral. The mean difference in the protracted scapula was 79mm with a 95%CI of 73mm to 85mm, and when retracted the difference was -49mm with a 95%CI from -41mm to -57mm. In the cadavers, the average distance between the spine and the greater tuberosity was 290 ± 12, 365 ± 15, and 209 ± 25 in neutral, protracted and retracted positions. The average length of the lower trapezius was 270 ± 10, 285 ± 12, and 258 ± 10 in the neutral, protracted, and retracted positions without prolongation with lumbar fascia. Transfer of the contralateral trapezius was feasible in all specimens when the scapula is partially retracted. When the detached lower trapezius is prolonged with lumbar fascia, the transfer was possible in all positions of the scapula. No tension or impingement on the neurovascular pedicle was observed.  Pulling on the transferred muscle was effective in externally rotating the contralateral shoulder.

Conclusion: Based on this study, contralateral trapezius transfer to the infraspinatus appears to be feasible and potentially effective in restoring external rotation. This finding adds a new tendon transfer possibility in paralytic shoulders when no ipsilateral muscles are available. 

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