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CC BY 4.0 · J Brachial Plex Peripher Nerve Inj 2024; 19(01): e13-e19
DOI: 10.1055/s-0044-1786817
Original Article

Long-Term Results of Isolated Latissimus Dorsi to Rotator Cuff Transfer in Brachial Plexus Birth Injury

David J. Kirby 
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York, United States
,
Daniel B. Buchalter
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York, United States
,
Lauren Santiesteban
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York, United States
,
Mekka R. Garcia
2   Department of Neurology, NYU Langone Health, New York, New York, United States
,
Aaron Berger
3   Deparment of Orthopedic Surgery, Nicklaus Children's Hospital, Miami, Florida, United States
,
Jacques Hacquebord
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York, United States
,
John A.I. Grossman
3   Deparment of Orthopedic Surgery, Nicklaus Children's Hospital, Miami, Florida, United States
,
Andrew E. Price
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York, United States
› Author Affiliations Funding The author(s) received no financial support for the research, authorship and/or publication of this article.
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Abstract

Background Brachial plexus birth injury results in deficits in strength and motion, occasionally requiring surgery to restore power to the deficient external rotators of the shoulder in these patients. This is a retrospective analysis of the long-term results of an isolated latissimus dorsi transfer to the rotator cuff in patients with brachial plexus birth injury.

Methods This is a retrospective review of prospectively collected data for patients undergoing isolated latissimus dorsi transfer into the infraspinatus in addition to release of the internal rotation contracture of the shoulder with greater than 5 years' follow-up. Preoperative and postoperative shoulder elevation and external rotation were documented. Failure of surgery was defined as a return of the internal rotation contracture and a clinically apparent clarion sign.

Results A total of 22 patients satisfied the inclusion criteria: 9 global palsies and 13 upper trunk palsies. The average follow-up was 11 years, ranging from 7.5 to 15.9 years. There was a trend for improved external rotation in the global palsy cohort at final follow-up (p = 0.084). All nine global palsies maintained adequate external rotation without a clarion sign. Five of the 13 upper trunk palsies failed the latissimus dorsi transfer and subsequently required either teres major transfer and/or rotational osteotomy. In these five failures, the period from initial transfer to failure averaged 6.6 years, ranging from 3.4 to 9.5 years.

Conclusion The results of this study indicate that patients with global palsy have sustained long-term improved outcomes with isolated latissimus dorsi transfer while patients with upper trunk palsy have a high rate of failure. Based on these results, we recommend isolated latissimus dorsi transfer for global palsy patients who have isolated infraspinatus weakness.

Level of Evidence: Case series – Level IV.

Keywords

brachial plexus birth injury - latissimus transfer - brachial plexus palsy - global palsy - upper trunk palsy - clarion sign

Financial Remunerations

None.




Publication History

Received: 22 October 2022

Accepted: 25 April 2023

Article published online:
12 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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