What is a Tendon Transfer for Dysfunctional Scapula Muscles?
Tendon transfer for dysfunctional scapula muscles is a surgical procedure aimed at restoring function to the shoulder when one or more of the scapula muscles (such as the trapezius, serratus anterior, or rhomboids) are weak or paralyzed. This can result from nerve injuries, muscular dystrophy, or other causes of muscle dysfunction. The goal of tendon transfer is to restore shoulder stability and improve the range of motion and function by transferring a healthy, functioning tendon from another part of the body or shoulder to compensate for the dysfunctional ones.
What are the Common Tendon Transfer Procedures for Scapula Muscle Dysfunction?
- Eden-Lange Procedure: This is the most commonly used tendon transfer for scapula winging due to trapezius or rhomboid dysfunction. The rhomboid major, rhomboid minor, and levator scapulae muscles are repositioned to provide better stability of the scapula.
- L’Episcopo Procedure: In this procedure, the latissimus dorsi and teres major muscles are transferred to improve scapular and shoulder function, often used for patients with brachial plexus injuries.
- Serratus Anterior Tendon Transfer: For patients with long thoracic nerve palsy and resultant winging of the scapula, tendon transfer from muscles like the pectoralis major may be performed to compensate for serratus anterior dysfunction.
Indications for Tendon Transfer for Dysfunctional Scapula Muscles
Tendon transfer for dysfunctional scapular muscles is typically indicated for the following conditions:
- Scapular winging: Often caused by long thoracic nerve injury leading to paralysis of the serratus anterior muscle, which holds the scapula flat against the rib cage.
- Trapezius palsy: Dysfunction of the trapezius muscle, which helps stabilize and move the scapula.
- Other nerve-related muscle dysfunction: Issues with other muscles like the rhomboids or levator scapulae, affecting shoulder movement and stability.
Preparation for Tendon Transfer for Dysfunctional Scapula Muscles
Preparation for a tendon transfer for dysfunctional scapula muscles may include the following:
- A thorough medical evaluation, including physical examination, medical history review, and laboratory tests to ensure the patient is fit for surgery
- Imaging studies, such as MRI and CT scans, and nerve studies (EMG) to identify the exact muscle (s) involved (for example, serratus anterior, trapezius, rhomboids)
- Informing your doctor of any allergies to medications, anesthesia, or latex
- Providing your physician with a list of any medications or supplements you are taking
- You may need to adjust or temporarily stop taking certain medications - especially those that can affect blood clotting
- Abstaining from food or drink for at least 8 hours prior to the surgery
Procedure for Tendon Transfer for Dysfunctional Scapula Muscles
Tendon transfer for dysfunctional scapula muscles is typically performed under general anesthesia and involves the following steps:
- Your surgeon makes an incision, typically over the shoulder, chest, or back, depending on the donor tendon and target muscle.
- The dysfunctional tendon or muscle is identified, and the surgeon carefully isolates it from surrounding tissues.
- The donor tendon (such as the pectoralis major for long thoracic nerve palsy) is detached from its original insertion.
- The donor tendon is mobilized and rerouted to the area where it will compensate for the dysfunctional muscle. For example, in the case of pectoralis major transfer for serratus anterior dysfunction, the tendon is rerouted to the scapula to help stabilize it.
- The tendon is securely fixed to the bone (often the scapula or humerus) using sutures, anchors, or screws to ensure proper attachment.
- The surgeon ensures that the transferred tendon is placed under the correct tension to allow it to function effectively in its new role, mimicking the action of the original muscle.
- After the tendon transfer is complete, the incision is closed using sutures, and sterile dressings are applied.
Postoperative Care and Recovery
After surgery, the arm is typically immobilized in a sling or shoulder immobilizer to protect the transfer and allow healing. Post-surgical pain is managed with medications, including opioids and anti-inflammatory drugs. Early passive range of motion exercises are usually introduced under guidance by a physical therapist to prevent stiffness. After the tendon heals in its new position, strengthening exercises are incorporated to train the transferred tendon to perform its new function. Full recovery and functional gains may take 6-12 months depending on the severity of the original dysfunction and the patient’s compliance with rehabilitation. Follow-up appointments will be scheduled to monitor progress and address any concerns.
Risks and Complications
Risks and complications associated with a tendon transfer for dysfunctional scapula muscles may include:
- Infection
- Bleeding
- Limited shoulder mobility
- Tendon failure or re-rupture
- Persistent scapular instability or pain
- General anesthesia risks
