OVERVIEW

Tendon transfers for brachial plexus injuries may be considered in patients with a peripheral axillary nerve injury or an upper trunk brachial plexus injury resulting in a paralysed shoulder, while hand and elbow function remain intact.

In carefully selected patients, tendon transfer surgery may help restore useful shoulder function by redirecting a functioning muscle to compensate for the muscles that are no longer working. This may involve an isolated pectoralis major tendon transfer to the shoulder.

In more complex cases, a combination of procedures may be required. This can include total shoulder replacement together with multiple tendon transfers, depending on which muscles and structures remain functional and are available for reconstruction. The aim is to restore useful shoulder movement, including forward flexion of the arm.

These procedures are highly specialised and are not commonly performed. Dr Jason du Plessis has undertaken additional training in these techniques through visits to Annecy Advanced shoulder course in France and to Atlanta in the United States, where he worked and liaised with experienced surgeons to develop his expertise in complex tendon transfer procedures for patients with chronic shoulder paralysis.

This experience has enabled Dr du Plessis to offer reconstructive options for selected patients with chronic shoulder paralysis where conventional treatment options may be limited.

Types Of Shoulder Tendon Transfer:

Different tendon transfers may be considered depending on the muscles affected, the type of shoulder dysfunction and the patient's individual goals.

1. Pedicle Pectoralis Major Transfer

A pectoralis major transfer uses the large, powerful pectoralis major muscle to compensate for the function of a damaged or non-functioning muscle around the shoulder. The muscle and tendon are carefully mobilised while preserving their nerve and blood supply before being transferred to a new attachment site. This allows the pectoralis major to perform a new function and assist with restoring useful shoulder movement.

2. Latissimus Dorsi Tendon Transfer

A latissimus dorsi tendon transfer uses the powerful latissimus dorsi muscle to restore specific shoulder movements that have been lost due to irreparable muscle, nerve or tendon damage. The tendon is carefully released from its original attachment and transferred to a new position around the shoulder. The muscle can then assist with movement that was previously performed by the damaged muscle or tendon.

INDICATIONS

Tendon transfer surgery may be considered when a shoulder muscle or tendon is no longer suitable for conventional repair or reconstruction.

Common indications include:

1. Irreparable rotator cuff tears: Severe or longstanding rotator cuff damage where the tendon cannot be repaired directly.
2. Severe tendon damage: Extensive damage resulting from injury, previous surgery or chronic degeneration.
3. Loss of muscle function: Significant weakness or loss of movement caused by damage to the muscles or tendons responsible for shoulder function.
4. Failed previous surgery: Persistent loss of function following previous shoulder procedures in selected patients.
5. Complex shoulder injuries: Injuries where conventional reconstructive options are limited.

A thorough assessment, including a clinical examination and appropriate imaging, is required to determine whether a tendon transfer is appropriate.