Transfer of the Trapezius to the Deltoid for Treatment of Shoulder Instability after Lesions of the Brachial Plexus

Objective: To clarify the indications and to describe the surgical technique and outcomes of surgery involving transfer of the trapezius to the deltoid for the treatment of lesions of the brachial plexus in patients with multidirectional instability in the shoulder. Method: In 17 patients (mean age, 23 years) operated at Sao Vicente de Paulo Hospital and the Institute of Orthopedics and Traumatology of Passo Fundo, Brazil from?1999 to 2009, we performed trapezius transfer to the proximal humerus. In these patients, the mean interval between trauma and surgery was 8 months. Results: Functional improvement and resolution of multidirectional instability of the shoulder were observed in all the patients. No patient showed immediate postoperative complications. The mean active mobility was as follows: 95° flexion, 50° abduction, 45° external rotation, and internal rotation at the level of the first lumbar vertebra (L1). The trapezius muscle strength was classified as grade III, and the UCLA functional outcome was 22 points. The postoperative satisfaction was excellent, and occasional pain and weakness was reported by all the patients. Conclusions: Transfer of the trapezius muscle to the proximal humerus provides better results in patients with a more than 6-month-old lesion. This procedure also preserves passive mobility of the limb, confers shoulder stability, provides active mobility, and prevents osteoarthrosis.

Transfer of upper trapezius with clavicular segment for restoration of shoulder movements following injury to the brachial plexus

Aim:Most brachial plexus palsies occur following high-velocity trauma.The shoulder joint is a large proximal joint which influences the motion of the hand.Transfer of the trapezius muscle is an effective alternative for palsy of the deltoid and supraspinatus muscles.Methods:Between 2009 and 2014,32 patients were treated with modified trapezius muscle transfer in which only the descending fibers along with their attachment to the lateral third of clavicle were used.The clavicle was fixed to the anterolateral surface of the humerus by cancellous screws.The arm was immobilized for 6 weeks.Results:All the 32 patients had improved function with stability of the shoulder.The average increase in active abduction was from 7.5°(range:0°-30°)to 85°(range:45°-140°),and the mean forward flexion increased from 5.63°(range:0°-15°)to 55.2°(range:40°-90°)after a mean follow-up of 8.25 months.Twenty-four of the 32 patients rated the result as good to excellent and were satisfied with the improvement in stability and function.Fifty nine point thirty eight percent patients had Medical Research Council Muscle power 4 after the surgery.Conclusion:Transfer of the upper trapezius muscle with a segment of the clavicle segment for a flail shoulder can provide satisfactory function and stability with fewer complications.

Instrumented assisted soft tissue mobilization vs extracorporeal shock wave therapy in treatment of myofascial pain syndrome

BACKGROUND Active myofascial trigger points(TrPs)often occur in the upper region of the upper trapezius(UT)muscle.These TrPs can be a significant source of neck,shoulder,and upper back pain and headaches.These TrPs and their related pain and disability can adversely affect an individual’s everyday routine functioning,work-related productivity,and general quality of life.AIM To investigate the effects of instrument assisted soft tissue mobilization(IASTM)vs extracorporeal shock wave therapy(ESWT)on the TrPs of the UT muscle.METHODS A randomized,single-blind,comparative clinical study was conducted at the Medical Center of the Egyptian Railway Station in Cairo.Forty patients(28 females and 12 males),aged between 20-years-old and 40-years-old,with active myofascial TrPs in the UT muscle were randomly assigned to two equal groups(A and B).Group A received IASTM,while group B received ESWT.Each group was treated twice weekly for 2 weeks.Both groups received muscle energy technique for the UT muscle.Patients were evaluated twice(pre-and posttreatment)for pain intensity using the visual analogue scale and for pain pressure threshold(PPT)using a pressure algometer.RESULTS Comparing the pre-and post-treatment mean values for all variables for group A,there were significant differences in pain intensity for TrP1 and TrP2(P=0.0001)and PPT for TrP1(P=0.0002)and TrP2(P=0.0001).Also,for group B,there were significant differences between the pre-and post-treatment pain intensity for TrP1 and TrP2 and PPT for TrP1 and TrP2(P=0.0001).There were no significant differences between the two groups in the post-treatment mean values of pain intensity for TrP1(P=0.9)and TrP2(P=0.76)and PPT for TrP1(P=0.09)and for TrP2(P=0.91).CONCLUSION IASTM and ESWT are effective methods for improving pain and PPT in patients with UT muscle TrPs.There is no significant difference between either treatment method.

Anatomy and clinical application of suprascapular nerve to accessory nerve transfer

BACKGROUND Loss of motor function in the trapezius muscle is one complication of radical neck dissection after cutting the accessory nerve(AN) during surgery.Nerve repair is an effective method to restore trapezius muscle function,and includes neurolysis,direct suture,and nerve grafting.The suprascapular nerve(SCN) and AN are next to each other in position.The function of the AN and SCN in shoulder elevation and abduction movement is synergistic.SCN might be considered by surgeons for AN reanimation.AIM To obtain anatomical and clinical data for partial suprascapular nerve-to-AN transfer.METHODS Ten sides of cadavers perfused with formalin were obtained from the Department of Human Anatomy,Histology and Embryology,Peking University Health Science Center.The SCN(n = 10) and AN(n = 10) were carefully dissected in the posterior triangle of the neck,and the trapezius muscle was dissected to fully display the accessory nerve.The length of the SCN from the origin of the brachial plexus(a point) to the scapular notch(b point) and the distance of the SCN from the origin point(a point) to the point(c point) where the AN entered the border of the trapezius muscle were measured.The length and branches of the AN in the trapezius muscle were measured.A female patient aged 55 years underwent surgery for partial SCN to AN transfer at Department of Oral and Maxillofacial Surgery,Peking University School and Hospital of Stomatology.The patient suffered from recurrent upper gingival cancer.Radical neck dissection was performed on the right side,and the right AN was removed at the intersection between the nerve and the posterior border of the SCM muscle.One-third of the diameter of the SCN was cut off,and combined epineurial and perineurial sutures were applied between the distal end of the cut-off fascicles of the SCN and the proximal end of the AN without tension.Both subjective and objective evaluations were performed before,three months after,and nine months after surgery.For the subjective evaluation,the questionnaire included the Neck Dissection Impairment Index(NDII) and the Constant Shoulder Scale.Electromyography was used for the objective examination.Data were analyzed using t tests with SPSS 19.0 software to determine the relationship between the length of the SCN and the linear distance.A P value of < 0.05 was considered as statistically significant.RESULTS The whole length of the AN in the trapezius muscle was 16.89 cm.The average numbers of branches distributed in the descending,horizontal and ascending portions were 3.8,2.6 and 2.2,respectively.The diameter of the AN was 1.94 mm at the anterior border of the trapezius.The length of the suprascapular nerve from the origin of the brachial plexus to the scapular notch was longer than the distance of the suprascapular nerve from the origin point to the point where the accessory nerve entered the upper edge of the trapezius muscle.The amplitude of trapezius muscle electromyography indicated that both the horizontal and ascending portions of the trapezius muscle on the right side had better function than the left side nine months after surgery.The results showed that the right-sided supraspinatus and infraspinatus muscles did not lose more function than the left side.CONCLUSION Based on anatomical data and clinical application,partial suprascapular nerve-to-AN transfer could be achieved and may improve innervation of the affected trapezius muscle after radical neck dissection.

斜方肌肌皮瓣在头颈肿瘤术后缺损中应用

斜方肌肌皮瓣是由斜方肌及其表面覆盖的皮肤、软组织组成的一种带血管蒂的复合组织瓣。血液供应主要来自颈横动脉、枕动脉分支;根据其解剖特点,分为上斜方肌皮瓣、外侧斜方肌皮瓣、下斜方肌皮瓣;可修复颈部、颅顶、面颊、口腔、颞部和侧颅底的组织缺损;是头颈肿瘤术后缺损修复的重要组织瓣之一。本文对其解剖及应用进展进行综述。