Results of lower trapezius transfer for restoration of shoulder external rotation in patients with brachial plexus injury

Brachial plexus injury is a rare condition but result in serious disability.Today withmicrosurgical technique improvement and also popularization of nerve transfer,greatimprovement was achieved in functional recovery of these patients.In spite of thistruth,results of these treatment method is not complete and perfect.One of theproblem in these patients at the end of recovery period is weakness of shoulderexternal rotation which has been occurred in one third of patients.Although transferof lower third of trapezius is well known and conventional method especially inpatients with poliomyelitis , today this procedure was introduced in patients withbrachial plexus injury and also rotator cuff injury.In this study we reviewed results of this procedure in treatment of our patients.Since May 2015 till January 11 , 2018 patients with brachial plexus injury who hadmuscle power greater than 5/2 in shoulder abduction and elbow flexion but due toweakness of shoulder external rotation could not used their extremity underwent lower trapezius transfer with technique of Elhassan_Valenti.8 man and 3 woman with age between 43-18 and traumatic upper brachial plexusinjury were operated .2 of 11 patients had spontaneous recovery of shoulderabduction and elbow flexion and 9 of 11 patients had shoulder abduction and elbowflexion improvement after previous nerve transfer.In all patient spinal accessorynerve were intact.In 7 patients who underwent lower trapezius transfer ,shoulder external rotation wasimproved after single operation and in 1 case external rotation was improved aftersecond revision surgery.In 3 patients external rotation didn’t had any improvement.external rotation were between 120_40 with mean degree of 88 and mean QuickDASH score decreasd from 64 to 28 within 6 months follow up.Transfer of lower trapezius result in functional recovery in patient with brachial plexusinjury so preservation of spinal accessory nerve is very important in primary surgery