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Contralateral Trapezius Transfer for Brachial Plexus Birth Injury-Related Scapulothoracic Abnormal Motion in Children: A Prospective Cohort Study
Alejandro J. Friedman, MA
1, Victoria Robbins, BS
1, Joey S. Kurtzman, MD
2; Steven M. Koehler, M.D.
1(1)Montefiore Medical Center, Bronx, NY, (2)Wake Forest School of Medicine, Winston Salem, NC
Introduction: Brachial Plexus Birth Injury (BPBI) is common and can have residual deficits persisting into adulthood. The combination of sequelae can lead to scapulothoracic abnormal motion (STAM), preventing patients from achieving full recovery of overhead function. However, muscle transfers such as contralateral trapezius transfers assist in correcting this deformity. First described as a tertiary procedure in adults, we apply this technique for reconstructive scapular stabilization during the initial shoulder reanimation procedure to restore function in children.
Materials and Methods: Eight pediatric patients from a single institution who sustained non-transient BPBI presenting with suboptimal shoulder function and STAM on exam underwent surgery with this combined approach. Outcome measures included Active Movement Scale (AMS) scores in shoulder abduction, shoulder flexion, and shoulder external rotation, modified Mallet scores, and repetitive visual inspection for assessing scapular positioning (symmetry, medialization, and resolution of shrugging). Descriptive statistics, median and interquartile range, nonparametric tests, and Wilcoxon signed-rank tests were employed to analyze data.
Results: Postoperatively, all patients demonstrated medialization of the scapula, volitional scapular control and restoration of scapular symmetry. In addition, all patients achieved significant improvement in shoulder function by AMS scores and in all modified Mallet scores except hand to neck. One patient required additional surgery for elbow reanimation unrelated to restoration of shoulder function.
Conclusions: When performed during initial reanimation, the contralateral trapezius transfer offers a significant advantage by providing early dynamic scapular stabilization, significantly improving shoulder functional outcomes, reducing the need for secondary surgeries, and improving pediatric BPBI patients' quality of life.
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