Trapezius Muscle Transfer for Restoration of Elbow Extension in a Traumatic Brachial Plexus Injury

Voluntary elbow extension is essential for optimal upper limb positioning required for daily living activities, particularly above-shoulder maneuvers. The authors present a case of traumatic brachial plexus injury in which paralysis of the musculature selectively supplied by the posterior cord was based on magnetic resonance imaging and nerve conduction studies. An attempt at a radial nerve graft at another center was not effective. Ipsilateral hand function improved after multiple local tendon transfers were performed. Restoration of active elbow extension was not possible using the posterior deltoid or the latissimus dorsi because they were denervated by the primary trauma and so the trapezius muscle was used as a donor muscle unit to restore voluntary elbow extension. The patient resumed biking 6 weeks after the transfer procedure. At 2-year follow-up, full active elbow extension was regained, elbow extension power scored 4 of 5, and the patient reported that he could ride his bicycle for 70 miles.