Tendon Transfer Options About the Shoulder in Patients with Brachial Plexus Injury by Bassem Elhassan, Allen T. Bishop, Robert U. Hartzler, Alexander Y.

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Presentation transcript:

Tendon Transfer Options About the Shoulder in Patients with Brachial Plexus Injury by Bassem Elhassan, Allen T. Bishop, Robert U. Hartzler, Alexander Y. Shin, and Robert J. Spinner J Bone Joint Surg Am Volume 94(15): August 1, 2012 ©2012 by The Journal of Bone and Joint Surgery, Inc.

Preoperative anteroposterior radiograph of the shoulder showing inferior subluxation of the humeral head at the glenohumeral joint. Bassem Elhassan et al. J Bone Joint Surg Am 2012;94: ©2012 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2 Drawing showing positioning of the patient at the time of the surgery. Bassem Elhassan et al. J Bone Joint Surg Am 2012;94: ©2012 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3 Raising of the skin flaps allows full exposure of the posterior aspect of the scapula and the trapezius attachments. Bassem Elhassan et al. J Bone Joint Surg Am 2012;94: ©2012 by The Journal of Bone and Joint Surgery, Inc.

The lower portion of the trapezius with its tendinous insertion on the medial spine of the scapula (long black arrow) and the added deltoid fascia extension (short black arrow). Bassem Elhassan et al. J Bone Joint Surg Am 2012;94: ©2012 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5 Detachment of the lower portion of the trapezius (black arrow, near lower forceps) and of the upper and middle portions of the trapezius with its acromial attachment (purple arrow, near upper forceps). Bassem Elhassan et al. J Bone Joint Surg Am 2012;94: ©2012 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6 Detachment of the insertion of the levator scapulae (red arrow) with a small osseous attachment. Bassem Elhassan et al. J Bone Joint Surg Am 2012;94: ©2012 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7 Detachment of the insertion of the upper portion of the serratus anterior (blue arrow) with a small osseous attachment. Bassem Elhassan et al. J Bone Joint Surg Am 2012;94: ©2012 by The Journal of Bone and Joint Surgery, Inc.

Intraoperative photograph showing the patient in the semilateral position (right side facing the ceiling, head toward the left, and spine toward the bottom). Bassem Elhassan et al. J Bone Joint Surg Am 2012;94: ©2012 by The Journal of Bone and Joint Surgery, Inc.

Intraoperative photograph of the patient in Figure 8 showing the detached teres major muscle. Bassem Elhassan et al. J Bone Joint Surg Am 2012;94: ©2012 by The Journal of Bone and Joint Surgery, Inc.

Intraoperative photograph of a different patient showing a pedicled latissimus dorsi transfer to the anterior aspect of the shoulder to replace the anterior portion of the deltoid muscle. Bassem Elhassan et al. J Bone Joint Surg Am 2012;94: ©2012 by The Journal of Bone and Joint Surgery, Inc.

Postoperative anteroposterior radiograph of the shoulder showing a well-reduced glenohumeral joint. Bassem Elhassan et al. J Bone Joint Surg Am 2012;94: ©2012 by The Journal of Bone and Joint Surgery, Inc.