What is Shoulder Tendon Transfer?
A shoulder tendon transfer is a surgical procedure used to restore shoulder function by transferring a tendon from one muscle to another area to compensate for lost muscle function or to stabilize the joint. This technique is often employed when a patient has significant shoulder weakness or dysfunction due to conditions such as irreparable rotator cuff tears, nerve injuries (e.g., brachial plexus or axillary nerve damage), paralysis of specific shoulder muscles, and chronic shoulder instability. The aim of shoulder tendon transfer is to restore shoulder motion and strength, improve stability and reduce pain, and enable activities of daily living and improve quality of life.
What are the Commonly Used Tendons for Shoulder Tendon Transfer?
Tendons used for transfer are typically chosen based on their proximity to the shoulder, their function, and the availability of viable donor muscles. Common tendon transfers include:
- Latissimus Dorsi Tendon Transfer: Used for irreparable posterosuperior rotator cuff tears.
- Pectoralis Major Tendon Transfer: Often for irreparable subscapularis tears (anterior rotator cuff).
- Lower Trapezius Tendon Transfer: Used for irreparable infraspinatus or teres minor tears.
Indications for Shoulder Tendon Transfer
Common indications for shoulder tendon transfer include:
- Patients with massive, irreparable rotator cuff tears.
- Shoulder muscle paralysis, especially due to nerve damage.
- Chronic instability or joint dysfunction not treatable with conventional repairs.
Procedure for Shoulder Tendon Transfer
In general, shoulder tendon transfer surgery is typically performed under general anesthesia and will involve the following steps:
- The surgeon makes an incision over the shoulder to access the injured tendon and the tendon to be transferred.
- The selected tendon (e.g., latissimus dorsi, pectoralis major, or lower trapezius) is carefully detached from its insertion point while preserving its blood supply and nerve function.
- The harvested tendon is prepared by trimming or reinforcing it as needed to facilitate the transfer.
- The harvested tendon is then mobilized and rerouted to the desired location in the shoulder, where it can take over the function of the damaged tendon.
- The tendon is anchored to the bone using suture anchors or other fixation devices. Precise tensioning ensures proper function.
- The surgeon may adjust the surrounding tissues to accommodate the new tendon position and ensure smooth movement.
- The tendon is tested intraoperatively to verify the range of motion and stability.
- The surgical site is closed with sutures, and sterile dressings are applied.
Postoperative Care and Recovery
Postoperative care for shoulder tendon transfer involves a structured rehabilitation plan to ensure proper healing and restore function. Initially, the arm is immobilized in a sling or brace for 4–6 weeks to protect the repair and allow the transferred tendon to heal in its new position. During this period, patients perform passive range-of-motion exercises under supervision to prevent stiffness without straining the repair. After immobilization, physical therapy progresses to active-assisted and active exercises to gradually improve mobility. Strengthening exercises are introduced around 8–12 weeks post-surgery, focusing on retraining the transferred muscle to perform its new function. Full recovery, including a return to normal activities, may take 6–12 months, depending on the procedure's complexity and adherence to rehabilitation protocols. Regular follow-ups with the surgeon and physical therapist are crucial to monitor progress and prevent complications.
Risks and Complications
Some of the potential risks and complications associated with shoulder tendon transfer surgery include:
- Failure of the tendon transfer due to poor healing
- Infection or wound healing issues
- Stiffness or limited range of motion
- Persistent weakness or pain
- Rupture of the transferred attachment
- Damage to adjacent blood vessels and nerves
- Blood clots or deep vein thrombosis (DVT)
- Anesthesia-related risks