Back to 2026 Abstracts
Long-Term Functional Outcomes Following Tendon Transfers for Brachial Plexus Birth Injuries
Lainey Grey Bukowiec, MD, Emil Varas-Rodriguez, MPH, William J. Shaughnessy, MD; Nicholas Pulos, MD
Mayo Clinic, Rochester, MN
Introduction: Brachial plexus birth injuries (BPBI) can lead to permanent deficits in shoulder function, impacting a child's ability to perform basic activities with their upper extremity. While most patients recover, infants who do not recover function of the C5-C7 nerves may develop limitations in strength and function. Upper trunk injuries may result in internal contractions of the shoulder with marked muscular imbalances across the joint. Tendon transfer is a well-established procedure for improving shoulder function. While studies have demonstrated favorable results in the short term, long-term outcomes remain understudied. We aimed to assess long-term outcomes of patients <5 years old with BPBI who underwent tendon transfers.
Methods: A retrospective review of patients <5y/o who underwent tendon transfers for BPBI at a single, tertiary-referral center from 2000 to 2022 was conducted. Demographic characteristics, clinical and surgical variables, disease presentation and postoperative outcomes data were examined
Results: 88 patients were identified (61% female, 75% Caucasian). Patients were diagnosed with C5-C6 Erb's Palsy (71%), total plexus palsy (15%), and C5-C7 Palsy (14%). The average age at surgery was 28.6±14.7 months, and the average follow-up was 8.7±5.0 years. 24% of patients underwent prior nerve grafting or neurolysis. 61% underwent transfer of the latissimus dorsi and the teres major tendon, while individual latissimus dorsi transfers were performed in 32% of cases. 51% of tendons were inserted at the supraspinatus, while 49% were inserted at the infraspinatus (49%). Postoperatively, functional improvement was observed across all domains. The mean modified Mallet scores improved +0.60 for abduction, +0.99 for external rotation, and +1.13 for hand-to-mouth. 23.9% of patients underwent subsequent shoulder surgeries, the most common being coracoid excision (24%), humeral derotational osteotomy (14%), capsular release (14%), and acromial osteotomy (9%). Postoperatively, 8% of patients had complications that required revision of the tendon transfer. The complications were internal rotation contractures (50%), recurrent shoulder dislocation (25%), failure to improve (12.5%), and elbow contraction (12.5%).
Conclusions: Tendon transfer for BPBI in children results in lasting improvements in shoulder abduction, external rotation, and hand-to-mouth function. These improvements, quantified by improvement in Mallet sub-scores, translated clinically to enhanced ability to engage in activities of daily living. While postoperative complications and subsequent shoulder procedures were observed, revisions were infrequent. The present study is one of the largest series of young children with the longest follow-up after tendon transfer for BPBI. The reported findings may be utilized to guide surgical decision-making and familial education.
Back to 2026 Abstracts
