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Reverse Shoulder Arthroplasty Combined with a Modified Latissimus Dorsi and Teres Major Tendon Transfer for Shoulder Pseudoparalysis Associated with Dropping Arm

  • Symposium: New Approaches to Shoulder Surgery
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Although a reverse shoulder arthroplasty (RSA) can restore active elevation in the cuff deficient shoulder, it cannot restore active external rotation when both the infraspinatus and teres minor muscles are absent or atrophied. We hypothesized that a latissimus dorsi and teres major (LD/TM) transfer with a concomitant RSA would restore shoulder function and activities of daily living (ADLs). We prospectively followed 11 consecutive patients (mean age, 70 years) with a combined loss of active elevation and external rotation (shoulder pseudoparalysis and dropping arm) who underwent this procedure. All had severe cuff tear arthropathy (Hamada Stage 3, 4, or 5) and severe atrophy or fatty infiltration of infraspinatus and teres minor on preoperative MRI or CT-scan. The combined procedure was performed through a single deltopectoral approach in the same session. Postoperatively, mean active elevation increased from 70° to 148° (+78°) and external rotation from −18° to 18° (+36°). The Constant score, subjective assessment and ADLs improved. The combination of a RSA and LD/TM transfer restored both active elevation and external rotation in this selected subgroup of patients with a cuff deficient shoulder and absent or atrophied infraspinatus and teres minor.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Aldrige JM 3rd, Atkinson TS, Mallon WJ. Combined pectoralis major and latissimus dorsi transfer for massive rotator cuff deficiency. J Shoulder Elbow Surg. 2004;13:621–629.

    Article  Google Scholar 

  2. Aoki M, Okamura K, Fukushima S, Takahashi T, Ogino T. Transfer of latissimus dorsi for irreparable rotator-cuff tears. J Bone Joint Surg Br. 1996;78:761–766.

    PubMed  CAS  Google Scholar 

  3. Bartlet SP, May JW, Yarenchuk MJ. The latissimus dorsi muscle: a fresh cadaver study of the primary neurovascular pedicle. Plast Reconstr Surg. 1981;67:631–636.

    Article  Google Scholar 

  4. Beauchamps M, Beaton DE, Barnhill TA, Mackay M, Richards RR. Functional outcome after the l’Episcopo procedure. J Shoulder Elbow Surg. 1998;7:90–96.

    Article  Google Scholar 

  5. Boileau P, Baqué F, Valerio L, Ahrens P, Chuinard C, Trojani C. Isolated arthroscopic biceps tenotomy or tenodesis improve symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am. 2007;89:747–757.

    Article  PubMed  Google Scholar 

  6. Boileau P, Chuinard C, Roussanne Y, Neyton L, Trojani C. Modified latissimus dorsi and teres major transfer through a single delto-pectoral approach for external rotation deficit of the shoulder: as an isolated procedure or with a reverse arthroplasty. J Shoulder Elbow Surg. 2007;16:671–682.

    Article  PubMed  Google Scholar 

  7. Boileau P, Trojani C, Chuinard C. Latissimus dorsi and teres major transfer with reversed total shoulder arthroplasty for a combined loss of elevation and external rotation. Techn Shoulder Elbow Surg. 2007;8:13–22.

    Article  Google Scholar 

  8. Boileau P, Watkinson DJ, Hatzidakis AM, Balg F. Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg. 2005;14(Suppl S):147S–161S.

    Article  PubMed  Google Scholar 

  9. Boileau P, Watkinson DJ, Hatzidakis AM, Hovorka I. Neer Award 2005: the Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae and revision arthroplasty. J Shoulder Elbow Surg. 2006;15:527–540.

    Article  PubMed  Google Scholar 

  10. Boulahia A, Edwards TB, Walch G, Baratta RV. Early results of a reverse design prosthesis in the treatment of arthritis of the shoulder in elderly patients with a large rotator cuff tear. Orthopedics. 2002;25:129–133.

    PubMed  Google Scholar 

  11. Constant CR, Murley AHG. A clinical method for functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–164.

    PubMed  Google Scholar 

  12. Covey DC, Riordan DC, Milstead ME, Albright JA. Modification of the l’Episcopo procedure for brachial plexus birth palsy. J Bone Joint Surg Br. 1992;74:897–901.

    PubMed  CAS  Google Scholar 

  13. Edwards TB, Baghian S, Faust D, Willis RB. Results of latissimus dorsi and teres major transfer to the rotator cuff in the treatment of Erb’s palsy. J Pediatr Orthop. 2000;20:375–379.

    Article  PubMed  CAS  Google Scholar 

  14. Frankle M, Siegel S, Pupello D, Saleem A, Mighell M, Vasey M. The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am. 2005;87:1697–1705.

    Article  PubMed  Google Scholar 

  15. Freund RK, Terzis JK, Jordan L, Taylor G. Modified latissimus dorsi and teres major transfer for external rotation deficit of the shoulder. Orthopedics. 1986;9:505–506.

    PubMed  CAS  Google Scholar 

  16. Fuchs B, Weishaupt D, Zanetti M, Holder J, Gerber C. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg. 1999;8:599–605.

    Article  PubMed  CAS  Google Scholar 

  17. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2000;82:505–515.

    PubMed  CAS  Google Scholar 

  18. Gerber C, Maqueira G, Espinoza N. Latissimus dorsi transfer for the irreparable rotator cuff tears. J Bone Joint Surg Am. 2006;88:113–120.

    Article  PubMed  Google Scholar 

  19. Gerber C, Pennington SD, Lingenfelter EJ, Sukthankar A. Reverse Delta-III total shoulder replacement combined with latissimus dorsi transfer. A preliminary report. J Bone Joint Surg Am. 2007;89:940–947.

    Article  PubMed  Google Scholar 

  20. Gerber C, Vinh TS, Hertel R, Hess CW. Latissimus dorsi transfer for the treatment of massive tears of the rotator cuff. Clin Orthop Relat Res. 1988;232:51–61.

    PubMed  Google Scholar 

  21. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Clin Orthop Relat Res. 1994;304:78–83.

    PubMed  Google Scholar 

  22. Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics. 1993;16:65–68.

    PubMed  CAS  Google Scholar 

  23. Habermeyer P, Magosch P, Rudolph T, Lichtenberg S, Liem D. Transfer of the tendon of the latissimus dorsi for the treatment of massive tears of the rotator cuff. A new single-incision technique. J Bone Joint Surg Br. 2006;88:208–212.

    Article  PubMed  CAS  Google Scholar 

  24. Hamada K, Fukuda H. Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res. 1990;254:92–96.

    PubMed  Google Scholar 

  25. Hatzidakis AM, Norris TR, Boileau P. Reverse shoulder arthroplasty: indications, technique and results. Techn Shoulder Elbow Surg. 2005;6:135–149.

    Article  Google Scholar 

  26. Hertel R, Ballmer FT, Lambert SM, Gerber C. Lag signs in the diagnosis of rotator cuff rupture. J Shoulder Elbow Surg. 1996;5:307–313.

    Article  PubMed  CAS  Google Scholar 

  27. Herzberg G, Urien JP, Dimnet J. Potential excursion and relative tension of muscles in the shoulder girdle relevance to tendon transfer. J Shoulder Elbow Surg. 1999;8:430–437.

    Article  PubMed  CAS  Google Scholar 

  28. Hoffer M, Wickenden R, Roper B. Brachial plexus birth injuries. Results of tendon transfer of the rotator cuff. J Bone Joint Surg Am. 1978;60:691–695.

    PubMed  CAS  Google Scholar 

  29. Hurschler C, Wülker N, Windhagen H, Hellmers N, Plmuhoff P. Evaluation of the lag sign tests for external rotator function of the shoulder. J Shoulder Elbow Surg. 2004;13:298–304.

    Article  PubMed  Google Scholar 

  30. Iannoti J, Hennigan S, Herzog R, Kella S, Kelley M, Leggin B, Williams GR. Latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears. J Bone Joint Surg Am. 2006;88:342–347.

    Article  Google Scholar 

  31. Kirkos JM, Kirkos MJ, Kapenatos GA, Haritidis JH. Brachial plexus palsy secondary to birth injury. Long term results of anterior release and tendon transfers around the shoulder. J Bone Joint Surg Br. 2005;87:231–235.

    Article  PubMed  CAS  Google Scholar 

  32. l’Episcopo JB. Tendon transplantation in obstetrical paralysis. Am J Surg. 1934;25:122–125.

    Article  Google Scholar 

  33. l’Episcopo JB. Restoration of muscle balance in the treatment of obstetrical paralysis. N Y State J Med. 1939:357–363.

  34. Lester B, Jeong GK, Weiland AJ, Wieckewicz TL. Quadrilateral space syndrome: diagnosis, pathology, and treatment. Am J Orthop. 1999;28:718–722.

    PubMed  CAS  Google Scholar 

  35. Miniaci A, McLeod M. Transfer of the latissimus dorsi muscle after failed repair of a massive tear of the rotator cuff. A two to five year review. J Bone Joint Surg Am. 1999;81:1120–1127.

    PubMed  CAS  Google Scholar 

  36. Neer CS. Cuff tears, biceps lesions, impingement. The dropping sign. In: Neer CS, ed. Shoulder Reconstruction. Philadelphia, PA: WB Saunders Co; 1990:41–142.

    Google Scholar 

  37. Neer CS, Craig EV, Fukuda H. Cuff-tear arthropathy. J Bone Joint Surg Am. 1983;65:1232–1244.

    PubMed  Google Scholar 

  38. Pagnotta A, Haerle M, Gilbert A. Long-term results on abduction and external rotation of the shoulder after latissimus dorsi transfer for sequelae of obstetric palsy. Clin Orthop Relat Res. 2004;426:199–205.

    Article  PubMed  Google Scholar 

  39. Pearle AD, Kelly BT, Voos JE, Chehab EL, Warren RF. Surgical technique and anatomic study of latissimus dorsi and teres major transfers. J Bone Joint Surg Am. 2006;88:1524–1531.

    Article  PubMed  Google Scholar 

  40. Philips GH, Hoffer MM. Latissimus dorsi and teres major transfer to rotator cuff for Erb’s palsy. J Shoulder Elbow Surg. 1995;4:124–129.

    Article  Google Scholar 

  41. Schoierer O, Herzberg G, Berthonaud E, Dimnet J, Aswad R, Morin A. Anatomical basis of latissimus dorsi and teres major transfers in rotator cuff tear surgery with particular reference to neurovascular pedicles. Surg Radiol Anat. 2001;23:75–80.

    Article  PubMed  CAS  Google Scholar 

  42. Sirveaux F, Favard L, Oudet D, Huguet D, Lautman S. Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive and non repairable cuff rupture. In: Walch G, Boileau P, Molé D, eds. 2000 Shoulder Prosthesis...Two to Ten Year Follow-up. Montpellier, France: Sauramps Medical; 2001:247–252.

    Google Scholar 

  43. Strecker WB, McAllister JW, Manske PR, Schoenecker PL, Dailey LA. l’Episcopo transfers in obstetrical palsy: a retrospective review of twenty cases. J Pediatr Orthop. 1990;10:514–518.

    Google Scholar 

  44. Valenti PH, Boutens D, Nerot C. Delta 3 reversed prosthesis for arthritis with massive rotator cuff tear: long term results (> 5 years). In: Walch G, Boileau P, Molé D, eds. 2000 Shoulder Prosthesis...Two to Ten Year Follow-up. Montpellier, France: Sauramps Medical; 2001:253–259.

  45. Walch G, Boulahia A, Calderone S, Robinson AHN. The dropping and hornblower’s signs in evaluation of rotator cuff tears. J Bone Joint Surg Br. 1998;80:624–628.

    Article  PubMed  CAS  Google Scholar 

  46. Walch G, Edwards TB, Boulahia A, Nove-Josserand L, Neyton L, Szabo I. Arthroscopic treatment of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases. J Shoulder Elbow Surg. 2005;14:238–246.

    Article  PubMed  Google Scholar 

  47. Warner JP, Parsons IM. Latissimus dorsi tendon transfer. Comparison with primary and salvage reconstruction of massive irreparable rotator cuff tears. J Shoulder Elbow Surg. 2001;10:514–521.

    Article  PubMed  CAS  Google Scholar 

  48. Werner CML, Steinmann PA, Gilbart M, Gerber C. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am. 2005;87:1476–1486.

    Article  PubMed  CAS  Google Scholar 

  49. Zachary R. Transplantation of the teres major and latissimus dorsi for loss of external rotation at the shoulder. Lancet. 1947;2:757.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L’Archet, University of Nice-Sophia Antipolis, 151, Route de St Antoine de Ginestière, 06202, Nice, France

    Pascal Boileau MD, Christopher Chuinard MD, MPH, Yannick Roussanne MD, Ryan T. Bicknell MD, MSc, FRCS(C), Nathalie Rochet MD, PhD & Christophe Trojani MD, PhD

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  1. Pascal Boileau MD
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  2. Christopher Chuinard MD, MPH
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  3. Yannick Roussanne MD
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  4. Ryan T. Bicknell MD, MSc, FRCS(C)
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  5. Nathalie Rochet MD, PhD
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  6. Christophe Trojani MD, PhD
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Correspondence to Pascal Boileau MD.

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Each author certifies that he or she has no commercial associations that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution either has waived or does not require approval for the human protocol for this investigation and that all investigations conducted in conformity with ethical principles of research.

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Boileau, P., Chuinard, C., Roussanne, Y. et al. Reverse Shoulder Arthroplasty Combined with a Modified Latissimus Dorsi and Teres Major Tendon Transfer for Shoulder Pseudoparalysis Associated with Dropping Arm. Clin Orthop Relat Res 466, 584–593 (2008). https://doi.org/10.1007/s11999-008-0114-x

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  • DOI: https://doi.org/10.1007/s11999-008-0114-x

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