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Arthroscopic Lower Trapezius Transfer – Shoulder
Arthroscopic lower trapezius transfer for shoulder repair is a surgical process for restoration of shoulder functioning mainly in patients suffering from irreversible rotator cuff tears or substantial shoulder instabilities. This technique makes use of the lower trapezius muscle, which is structurally and functionally suited for compensating poor shoulder musculature, especially the external rotators as well as the posterior rotator cuff.
The trapezius muscle is a large and triangle-shaped muscle bridging the back of the neck and the upper thorax. It has three parts – upper, middle, and lower. The lower part starts from the thoracic vertebrae and enters into the scapula’s spine. It plays an important role in the stability and movement of the scapula, especially scapular depression and retraction, which is important for shoulder functioning.
When do you need lower trapezius transfer in the shoulder?
You need a lower trapezius transfer when you have the following indications:
Irreversible rotator cuff tears
When the rotator cuff is significantly damaged and it’s not possible to repair it directly, a muscle transfer is required. It’s also needed when a large portion of the rotator cuff becomes non-functional.
Previous treatment fails
When previous surgical repair fails to restore shoulder functioning, lower trapezius transfer helps.
Scapular dyskinesis
Abnormal scapula movement because of imbalance or dysfunctioning of muscle or often needs transfer of muscle for correction.
Surgical process
Positioning of patient and anesthesia
The patient is rested in a side decubitus position with general anesthesia. This position facilitates ideal access to the patient’s shoulder and scapula.
Assessment
At the start, arthroscopic screening of the shoulder is done to assess the degree of damage and to clean up degenerated tissues.
Gathering the lower trapezius
A posterior incision is done to identify the lower trapezius muscle and dissect it free from all attachments. It is done with proper care to preserve the neurovascular supply to the muscle.
Making a tunnel
A subcutaneous tunnel is made from the site of harvest to the shoulder. Through this tunnel, the lower trapezius tendon is transferred to its new point of insertion.
Fixing the tendon
After passing through the tunnel, the lower trapezius tendon is fastened to the greater tuberosity of the humerus or the infraspinatus tendon when functional. Several fixation methods, which also include suture anchors, can be utilized for proper attachment.
Closing and post-operation care
At last, the incision site is closed and the shoulder is kept immobilized in a specified position to protect the transfer and healing.
Outcomes
Several clinical studies, along with reports of patients, suggest that arthroscopic lower trapezius transfer gives good results. Patients mostly attain significant improvements in strength, motion, and overall functioning of the shoulder. The success percentage highly depends on proper surgical methods and adherence to post-operation rehabilitation procedures.
Conclusion
Arthroscopic lower trapezius transfer is the latest and most efficient surgical option for patients suffering from shoulder pathologies that can’t be treated with conservative treatment. By using the biochemical properties of the lower trapezius muscle, this method provides a good solution for the restoration of shoulder function, removing pain and enhancing the quality of life of patients with difficult shoulder conditions. As with other surgical techniques, expertise of the surgical team and commitment of the patient to rehabilitation are important for achieving positive outcomes.
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