Contralateral Lower Trapezius to Triceps Transfer for Restoring Elbow Extension in Patients with Brachial Plexus Palsy - A Technical Note.

Abstract

Restoration of elbow extension is seldom considered in the reconstructive plan for patients with extensive brachial plexus injury because of the scarcity of the nerve and tendon transfer options. However, restoring elbow extension could increase the outreach of hand and give better control of the elbow flexion. We propose a new technique for restoring elbow extension using the readily available contralateral lower trapezius (CLT). By extending the CLT with a fascia lata graft and transferring it to the triceps, we were able to restore elbow extension. In all four patients who underwent this procedure, anti-gravity (Grade-3) elbow extension was reliably achieved. Patients reported improved ability to reach for objects below shoulder level and expressed greater stability while handling a two-wheeler. This technique offers an effective method of restoring elbow extension in instances where the conventional ipsilateral donor muscles are not available for transfer. Level of Evidence: Level V (Therapeutic).