Outcome analysis of modified teres major and
latissimus dorsi transfer in the treatment of
obstetric brachial plexus palsy shoulder
sequelae
Gong Xu, Lu Lai Jin, Cui Jian Li, Sun Ru Tao
Department of Hand Surgery
The First Hospital of Ji Lin University
Chang Chun, Ji Lin Province
130021
obstetric brachial plexus palsy

Incidence：0.1-0.4%

Incomplete Recovery：49%-66%

Indication of Microsurgical Neural Reconstruction：
dysfunction of elbow flexion at the age of 3 month
Sequelae of shoulder
 C5，C6 injuries （Erb’s palsy）
 C5，C6，+C7 injuries （Erb’s palsy+C7）
 loss of active ER
 loss of shoulder elevation
Sequelae of shoulder
Loss of active shoulder
elevation and ER can lead to
simple tasks, such as shaking
hand, combing, brushing teeth,
becoming impossible due to the
inability of controlling the
spatial positioning of the arm .
Pathomechanics
Internal
Fibrosis , Contracture
Rotator
Loss of Passive ER
4
 Pectoralis Major
 Subscapularis
 Teres Major
 Latissimus Dorsi
External
Rotator
Palsy
Inability of active ER
2
 Infraspinatus
40%
 Teres Minor
Walch G, et al. The ‘dropping’ and ‘hornblower’s’ signs in evaluation of
rotator-cuff tears. JBJS-Br .1998
Shoulder Reconstruction
L’Episcopo Transfer ( 1934)
 Anterior Approach：Releasing Pectoralis Major and Subscapularis Muscles
 Posterior Approach：Transfer Teres Major & Latissimus Dorsi muscles
Reinserting conjoint tendon on humeral shaft
Shoulder Reconstruction
Nath (2007)
Axillary Approach
 Releasing Pectoralis Major and Subscapularis Muscles
 Conjoint tendon suturing to Teres Minor
Background
We modified Teres Major & Latissimus Dorsi transfer, from original L’Episcopo’s and
Nath’s procedures, to reconstruct shoulder function.
The deltopectoral approach to release contracted subscapularis, pectoralis major and
conjoint tendon of the teres major and latissimus dorsi
The posterior approach to reinsert the conjoint tendon to the belly of the teres minor
Background
To retrospectively analyze the outcomes and related factors of modified teres major and
latissimus dorsi transfer in the treatment of obstetric brachial plexus palsy (OBPP)
shoulder sequelae.
Materials and Methods
General Conditions
From 2008 to 2011
 six patients with OBPPs, aged from 16 months of age to 16 years of age.
 2 males and 4 females
 Left: 3, Right: 3
 No primary microsurgical reconstruction
 Diagnosis: C5+C6 (n=5)
C5+C6+C7 (n=1)
Materials and Methods
 The pre- and postoperative active shoulder abduction and ER were recorded and
evaluated according to Mallet’s classification.
 Comparison between the pre- and postoperative was performed by t-test.
Operative methods
Operative methods
Operative methods
Operative methods
Postoperative Management
 The upper extremities were immobilized for 6-8 weeks in the position of
abduction 90 degrees and ER 45 degrees except for two patients in the
position of adduction and internal rotation.
 All patients were followed for 3 to 22 months.
Results
130±24.5°
55±35.6
°
Pre-
Shoulder
Abduction
Post-
75°
Results
48.3±22.73°
External Rotation
Pre-
Post-
48°
Results
4.3
2.5
Mallet Score (ER)
Pre-
Post-
Typical Cases
 Preoperative: Abduction 70°, ER 0°( Mallet Score 3)
 Postoperative: Abduction 130°, ER 45°( Mallet Score 4)
Typical Cases
 Preoperative: Abduction 90°, ER 0°( Mallet Score 3)
 Postoperative: Abduction 160°, ER 90°( Mallet Score 5)
Typical Cases
 Preoperative: Abduction 50°, ER 0°( Mallet Score 3)
 Postoperative: Abduction 130°, ER 45°( Mallet Score 5)
The position of postoperative Immobilization can influence outcomes of ER
 2 patients were immobilized in shoulder adduction and internal rotation
Abduction
ER
Pre-
30
0
Post-
150
20
Abduction
ER
Pre-
0
0
Post-
90
45
Conclusion
 Modified teres major & latissimus dorsi transfer can improve shoulder
abduction and ER by increasing stability of the glenohumeral joint.
 The postoperative immobilization position can influence the improvement
of shoulder ER.
谢谢