Sekundäroperationen zur Verbesserung der Schulterfunktion nach Plexus brachialis-Läsion

The results of an integrated concept of therapy are presented including a description of indications and the various operative procedures to compensate insufficient shoulder muscles following brachial plexus lesion. PATIENTS AND METHODS: To improve stability and function of the shoulder in case of deltoid and supraspinatus paralysis 12 patients (1 female; 11 male; average age 29.4 years, range 17 to 56 years) underwent a shoulder arthrodesis. In 54 patients (11 female; 43 male; average age 30.3 years, range 18 to 69 years) a trapezius transfer was performed. The indication for a rotation osteotomy of the humerus to improve loss of external rotation due to paralytic infraspinatus muscle was determined in 4 male patients (average age 29.8 years, range 16 to 42 years). Our results are based upon an average follow-up of 2.0 (0.5-7.5) years after shoulder fusion, 1.9 (0.5-4.5) years after trapezius transfer and 1.6 (0.5-3.5) years after rotation osteotomy of the humerus. RESULTS: The trapezius transfer resulted in increased function of abduction of 6.2 degrees to 37.1 degrees (5 degrees-80 degrees) and forward flexion of 15.1 degrees to 36.2 degrees (10 degrees-90 degrees). A more stable condition of multidirectional shoulder instability was experienced by 50 patients (92.6%) and 49 patients (90.7%) were subjectively satisfied with the outcome of the operation. The strength and extent of functional improvement was, on average, greater following shoulder arthrodesis: abduction of 9.6 degrees to 65 degrees (40 degrees-90), forward flexion of 15.4 degrees to 59.2 degrees (30 degrees-90 degrees). 10 patients (83.3%) were subjectively satisfied with the outcome. Patients who had undergone external rotation osteotomy showed an average deficiency of external rotation of 20 degrees before operation. After osteotomy an improvement of 32.5 degrees to 12.5 degrees external rotation was achieved. All patients were satisfied with the increase of function. CONCLUSIONS: In patients with brachial plexus palsy, secondary operations according to the individual pattern of paralysis result in an improvement of shoulder function and stability as well as patients satisfaction.