What is this for?
Lower trapezius tendon transfer is indicated for patients with a massive rotator cuff tear and loss of external rotation strength of their arm. Patients are unable to control their arm in the horizontal plane and cannot maintain their arm in the position of a throwing motion. On some occasions, patients can lift their arm above their head but can’t rotate it in space.
In other situations patients have the complete inability to lift their arm at all (a condition called pseudoparalysis).
Who is this for?
This procedure is generally intended for younger patients who want to maintain a relatively active lifestyle. While reverse shoulder replacement can provide a predictable outcome, the long-term survivability of this is yet to be determined and the restrictions it places on the patient may not be viable for someone that wants to maintain a high level of activity. On frequent occasion, even older patients may not want to have their shoulder replaced and prefer alternative options.Historically, tendon transfers for massive rotator cuff tears have included latissimus dorsi tendon transfer or pectoralis major transfers with varying outcomes. Recently, the use of a lower trapezius tendon transfer has shown success in helping patients with massive tears with horizontal instability of their arm and may be a better option when a tendon transfer is performed based on biomechanical studies. Dr. Elhassan, formerly at the Mayo Clinic, has been a large proponent of this technique and educated other surgeons around the world on its technique and outcomes.
How is this done?
The surgery is done on an outpatient basis and takes between 1-2 hours. Most of the surgery is performed arthroscopically but an incision is necessary on your shoulder blade (3-5 inches) to allow for connection of the graft to your lower trapezius. This muscle inserts on the medial (inner) part of the scapula and connects to the spinae processes of the back. The tendon transfer is performed by connecting a cadaver graft (achilles tendon) to the humeral head thru multiple suture anchors and then weaving it into the lower trapezius tendon thru multiple sutures in the back of the shoulder. Dr. Badman uses a similar technique with slight modification as described by Dr. Elhassan.
Why does this help?
The trapezius normally functions to help stabilize the scapula (shoulder blade) and retract it. By transferring the tendon it then allows for external rotation of the arm as you squeeze your shoulder blades together. The brain is able to replicate this ability over time thru therapy and muscle memory. A recent biomechanical study by Hartlzer(J Shoulder ElbowSurg. 2012;21:1370–1376)demonstrated that the lower trapezius transfer was superior to other tendon transfers for its ability to restore this motion.
How long is recovery?
After surgery, the shoulder is immobilized in a special brace keeping the arm externally rotated for about 6 weeks. Internal rotation of the arm is avoided during this time. After 4-6 weeks from surgery, physical therapy is started working on passive motion where a skilled shoulder therapist will help move the arm. Progression to active motion will occur over the course of 10-12 weeks. Protection of the graft host junction is important and the reason for the slow progression. The healing of the connection points typically takes around 3 months. Improvement of motion and strength will occur over one year.
Patient Testimony:
4 months postop RIGHT surgery
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