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Original Article Plastic and Aesthetic Research

Transfer of upper trapezius with clavicular

segment for restoration of shoulder

movements following injury to the brachial

plexus

Neeraj Kant Agrawal
Department of Plastic Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, India.

Address for correspondence: Dr. Neeraj Kant Agrawal, Department of Plastic Surgery, Institute of Medical Sciences, Banaras Hindu University,
Varanasi 221005, Uttar Pradesh, India. E-mail: nkagrawal_vns@rediffmail.com

ABSTRACT
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.

Key words:
Brachial plexus, shoulder arthrodesis, trapezius transfer

INTRODUCTION arthrodesis to improve or restore function. A clear
understanding of shoulder anatomy and biomechanics is
Restoration of shoulder stability in posttraumatic plexopathy of paramount importance when using adjacent muscles
[3]
patients is critical in the preservation of distal for transfer. Options for transfer include the trapezius, [4,5]
[6]
[2]
[1]
function. However, the complexity of management can pectoralis major and teres major, latissimus dorsi and
be frustrating for both patient and surgeon. Primary combined biceps and triceps muscles.
surgery involves nerve repair, grafting and transfer The trapezius muscle has been extensively studied and
techniques. Failed operations for the shoulder may require used. Transfer of the trapezius insertion was first described
secondary procedures in the form of microneurovascular
[2]
free‑functioning muscle transfer, tendon transfers and This is an open access article distributed under the terms of the Creative Commons
Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix,
Access this article online tweak, and build upon the work non-commercially, as long as the author is credited
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Website: For reprints contact: reprints@medknow.com
www.parjournal.net
How to cite this article: Agrawal NK. Transfer of upper trapezius with
clavicular segment for restoration of shoulder movements following
DOI: injury to the brachial plexus. Plast Aesthet Res 2015;2:346-9.
10.4103/2347-9264.169503
Received: 30-05-2015; Accepted: 06-09-2015

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