PMC6727458_01
The active range of motion at 12-month post-surgery was as follows: 80  of elevation, 30  of abduction, and 0  of external rotation.
JOCR-9-56-g001.jpg
PMC6727458_01_JOCR-9-56-g001.jpg
F1
Considering that 6 months had passed since the time of trauma, we selected to perform a radial to axial nerve transfer, using the branch from the medial head of the triceps, while selecting to monitor the status of the suprascapular nerve injury, based on the incomplete paralysis of supraspinatus and infraspinatus. 6-month post-surgery, the contractile strength of the deltoid muscle had improved to M3, but without recovery of shoulder abduction and external rotation, with the significant restriction in shoulder motion persisting at 14-month post-injury, as follows: 80  of elevation, 30 of abduction, and 0 of external rotation (Fig. 1).
The upper-left panel shows transfer of the latissimus dorsi (LD) and teres minor (TM), with transfer of the lower trapezius shown in the upper-right panel. The lower panels show the attachment of the LD and TM, which were lengthened by the tensor fascia latae, and the lower trapezius to the humeral head.
JOCR-9-56-g002.jpg
PMC6727458_01_JOCR-9-56-g002.jpg
F2
The lower portion of the trapezius was elevated, along with the periosteum from the lateral margin, and directly sutured to the insertion of the infraspinatus muscle using an interlacing technique, without the use of an autogenous tendon (Fig. 2).
The active range of motion at 24-week post-surgery was as follows: 170  of elevation, 170  of abduction, and 60  of external rotation.
JOCR-9-56-g003.jpg
PMC6727458_01_JOCR-9-56-g003.jpg
F3
Moreover, muscle strength of external rotation had recovered to M4 (Fig. 3), with a Hand20 score of 13, compared to 30.5 preoperatively.