%0 Journal Article
%T Monopolar teres major muscle transposition to improve shoulder abduction and flexion in children with sequelae of obstetric brachial plexus palsy
%A J£¿rg Bahm
%A Claudia Ocampo-Pavez
%J Journal of Brachial Plexus and Peripheral Nerve Injury
%D 2009
%I Thieme Medical Publishers
%R 10.1186/1749-7221-4-20
%X In addition, we provide the clinical outcome in the first 17 operated children.Muscle weakness is a frequent sequela after obstetric brachial plexus palsy (obpp) and might be improved by muscle transpositions, especially at the shoulder level [1]. The teres major muscle (tmm) is included in the technique described by Hoffer [2] to enhance active lateral rotation of the shoulder, where this muscle should address the function of the infraspinatus muscle.We propose a single transfer of the tmm in selected conditions in children suffering obpp sequelae:1. when shoulder flexion and/or abduction are weak against gravity (active ROM less than 90¡ã with a strength less or equal M3)2. when the tmm shows cocontractions during shoulder abduction (mixed reinnervation of the dorsal cord)3. to add muscle volume to a cranial trapezius transfer for weak shoulder abduction4. to modify a Hoffer transfer [2], using the latissimus dorsi muscle (ldm) to improve the lateral shoulder rotation with an abducted arm, and tmm to allow an active abduction up to 90¡ã (horizontal line), which will bring the transferred ldm under good tension.Essentially, the tmm might be considered as a valuable functional muscle transfer to enhance shoulder abduction and elevation in selected children with obpp sequelae, under 10 years of age with reasonable body weight. The muscle thereby improves prime movers of the shoulder joint.The child is placed in a lateral position under general anesthesia. A double access is needed to the midaxillar line (to detach the muscle) and to the acromio-clavicular region (to transpose the muscle onto the antero-lateral deltoid muscle (dm) insertion).A strait skin incision is drawn beginning in the axilla following down the midaxillar line until the lower angle of the scapula. The subcutaneous tissue is divided, and the lateral borders of both ldm and tmm are identified and dissected free. The tmm is dissected free from the ldm progressively from its lateral border, from proxima
%U http://www.jbppni.com/content/4/1/20