L'Episcopo, J Bone Joint Surg Am 1934 - Tendon Transplantation in Obstetrical Paralysis

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Tendon Transplantation in Obstetrical Paralysis

L'Episcopo·J Bone Joint Surg Am·1934·269 citations·Case series

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L'Episcopo's 1934 case series describes a novel tendon transfer for residual shoulder internal rotation deformity in obstetrical brachial plexus palsy. The question addressed: can reversing the teres major's insertion restore active muscle balance and prevent deformity recurrence, rather than simply releasing contractures as prior operations did?

Key Findings

Teres major transfer reverses the muscle's action from internal to external rotation by re-anchoring its tendon under an osteoperiosteal flap on the posterolateral humerus — always performed after the Sever anterior release in the same operative setting
All 6 patients (July 1931–August 1933) showed marked functional improvement; transferred muscle was palpably felt contracting with active external rotation in every case
Earlier-operated patients showed the greatest improvement, suggesting the transferred muscle gains strength progressively with use
Prior operations (Sever release, Lange osteotomy, Kleinberg arthrodesis) addressed deformity mechanically but left the internal rotator imbalance intact, explaining why internal rotation recurred in some patients
The subscapularis — likely the greatest contributor to internal rotation deformity — was intentionally excluded from transfer due to its inaccessible anatomy and limited tendon length

Tendon Transplantation in Obstetrical Paralysis

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Tendon Transplantation in Obstetrical Paralysis

L'Episcopo·J Bone Joint Surg Am·1934·269 citations·Case series

|

L'Episcopo's 1934 case series describes a novel tendon transfer for residual shoulder internal rotation deformity in obstetrical brachial plexus palsy. The question addressed: can reversing the teres major's insertion restore active muscle balance and prevent deformity recurrence, rather than simply releasing contractures as prior operations did?

Key Findings

Teres major transfer reverses the muscle's action from internal to external rotation by re-anchoring its tendon under an osteoperiosteal flap on the posterolateral humerus — always performed after the Sever anterior release in the same operative setting
All 6 patients (July 1931–August 1933) showed marked functional improvement; transferred muscle was palpably felt contracting with active external rotation in every case
Earlier-operated patients showed the greatest improvement, suggesting the transferred muscle gains strength progressively with use
Prior operations (Sever release, Lange osteotomy, Kleinberg arthrodesis) addressed deformity mechanically but left the internal rotator imbalance intact, explaining why internal rotation recurred in some patients
The subscapularis — likely the greatest contributor to internal rotation deformity — was intentionally excluded from transfer due to its inaccessible anatomy and limited tendon length

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