This case series describes the triple-tendon (T3) transfer, an Eden-Lange variant, for chronic symptomatic trapezius paralysis after spinal accessory nerve injury. The technique reinserts the levator scapulae, rhomboid minor, and rhomboid major with their bony insertions at separate points along the scapular spine. It reports outcomes in 22 patients at intermediate follow-up.
When a patient has symptomatic trapezius paralysis that has not recovered after adequate observation, remember the treatment ladder. Conservative care beyond 1 year has limited success. Nerve repair gives variable results. Arthrodesis limits motion and fascial slings stretch and fail, which leaves tendon transfer as the preferred reconstruction.
The key teaching point is biomechanical. The trapezius externally rotates the scapula, so a good transfer must recreate its proximal-lateral to distal-medial line of pull. The original Eden-Lange rhomboid transfer pulls the wrong way and can drive internal rotation.
The T3 modification reinserts all three muscles with their bony insertions separately along the spine to fix that mismatch and promote bone healing. One practical pitfall: these three donor muscles are small and now suspend the entire scapula. Protect the transfer in a brace and do not start strengthening early, or the repair can rupture.
This case series describes the triple-tendon (T3) transfer, an Eden-Lange variant, for chronic symptomatic trapezius paralysis after spinal accessory nerve injury. The technique reinserts the levator scapulae, rhomboid minor, and rhomboid major with their bony insertions at separate points along the scapular spine. It reports outcomes in 22 patients at intermediate follow-up.
When a patient has symptomatic trapezius paralysis that has not recovered after adequate observation, remember the treatment ladder. Conservative care beyond 1 year has limited success. Nerve repair gives variable results. Arthrodesis limits motion and fascial slings stretch and fail, which leaves tendon transfer as the preferred reconstruction.
The key teaching point is biomechanical. The trapezius externally rotates the scapula, so a good transfer must recreate its proximal-lateral to distal-medial line of pull. The original Eden-Lange rhomboid transfer pulls the wrong way and can drive internal rotation.
The T3 modification reinserts all three muscles with their bony insertions separately along the spine to fix that mismatch and promote bone healing. One practical pitfall: these three donor muscles are small and now suspend the entire scapula. Protect the transfer in a brace and do not start strengthening early, or the repair can rupture.