scholarly journals Improved long-term functional outcome after a latissimus dorsi transfer with or without subscapularis muscle lengthening or release

2021 ◽  
Vol 87 (1) ◽  
pp. 151-157
Author(s):  
Stijn De Joode ◽  
Lazin Germawi ◽  
Martijn Schotanus ◽  
Juul Van der Lingen ◽  
Tom Van Mulken ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Latissimus Dorsi ◽  
External Rotation ◽  
Shoulder Function ◽  
Study Cohort ◽  
Entire Study ◽  
Subscapularis Muscle ◽  
Latissimus Dorsi Transfer

A brachial plexus birth injury (BPBI) can lead to a limited shoulder function, especially abduction and external rotation. One of the treatment options to restore those shoulder functions is a latissimus dorsi transfer (LDT). The aim of this study is to analyze long-term functional outcome after a single LDT and compare these results with LDT combined with subscapularis muscle lengthening (SSL) or subscapularis muscle release (SSR). This cohort study included 39 patients (≤12 years old) with one-sided BPBI. All patients had an inter- nal rotation- and adduction contracture without glenohumeral joint deformity. A LDT was performed with or without SSL or SSR, resulting in 3 patient study groups. Demographic data and pre- and post- operative Mallet scores were collected and analysed for each group. The median age was 4.0 years (IQR 3.1) and there were no differences in patient demographics. In all patients surgery improved external rotation and overall shoulder function, at 9.8 years follow-up. Also, the total Mallet score increased significantly with 1.7 (p=0.001) in our (entire) study cohort. A LDT, with a SSL or SSR in case of an intra-operative internal contracture, improves shoulder function and preserves external rotation in patients (≤12 years old) with BPBI, at a follow up of 9.8 years.

Lack of elevation and external rotation in the shoulder: Reverse total shoulder arthroplasty combined with latissimus dorsi transfer to the humerus versus the greater tuberosity

2019 ◽  
pp. 175857321988404
Author(s):  
Manuel Zafra ◽  
Pilar Uceda ◽  
Francisco Muñoz ◽  
Carmen Ruiz-Bonilla ◽  
Pilar Font
Keyword(s):  
Latissimus Dorsi ◽  
External Rotation ◽  
Total Shoulder Arthroplasty ◽  
Greater Tuberosity ◽  
Latissimus Dorsi Transfer ◽  
Group I ◽  
The Mean ◽  
Group Ii ◽  
Reverse Total Shoulder

Background The purpose of this study was to prospectively compare clinical outcomes of reverse total shoulder arthroplasty (RTSA) combined with latissimus dorsi transfer by modified L’Episcopo (Group I) versus the greater tuberosity (Group II) in patients with lack of elevation and external rotation in the shoulder. Materials and methods Eighteen patients participated in the study. They were placed randomly into two groups of nine patients in each group. The results were evaluated prior to surgery and at the end follow-up. Results The average follow-up was 33.2 months. The mean ASES scores improved from 13 points to 79 in Group I and from 15 to 73 in Group II. The mean Constant shoulder scores improved from 19 to 66 in Group I and from 18 to 67 in Group II. Mean active elevation increased from 59° to 147° in Group I and from 58° to 148° in Group II. The mean external rotation scores increased from −43° to 7° in Group I and from −41° to 23° in Group II. Conclusion Comparing clinical outcomes and active elevation, there were no significant differences. The latissimus dorsi transfer to the greater tuberosity provided greater external rotation than did the modified L’Episcopo transfer.

Long-Term Complications and Influence on Outcome in Patients Surviving Spontaneous Subarachnoid Hemorrhage

2020 ◽  
Vol 49 (3) ◽  
pp. 307-315 ◽  
Author(s):  
Stefan T. Gerner ◽  
Jonathan Reichl ◽  
Christina Custal ◽  
Sebastian Brandner ◽  
Ilker Y. Eyüpoglu ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Return To Work ◽  
Functional Outcome ◽  
Subjective Health ◽  
Study Cohort ◽  
Vp Shunt ◽  
Multivariable Analyses ◽  
Favorable Functional Outcome

Background: While the short-term clinical outcome of patients with subarachnoid hemorrhage (SAH) is well described, there are limited data on long-term complications and their impact on social reintegration. This study aimed to assess the frequency of complications post-SAH and to investigate whether these complications attribute to functional and self-reported outcomes as well as the ability to return to work in these patients. Methods: This retrospective single-center study included patients with atraumatic SAH over a 5-year period at a tertiary care center. Patients received a clinical follow-up for 12 months. In addition to demographics, imaging data, and parameters of acute treatment, the rate and extent of long-term complications after SAH were recorded. The functional outcome was assessed using the modified Rankin Scale (mRS; favorable outcome defined as mRS = 0–2). Further outcomes comprised self-reported subjective health measured by the EQ-5D and return to work for SAH patients with appropriate age. Multivariable analyses including in-hospital parameters and long-term complications were conducted to identify parameters independently associated with outcomes in SAH survivors. Results: This study cohort consisted of 505 SAH patients of whom 405 survived the follow-up period of 12 months (i.e., mortality rate of 19.8%). Outcome data were available in 359/405 (88.6%) patients surviving SAH. At 12 months, a favorable functional outcome was achieved in 287/359 (79.9%) and 145/251 (57.8%) SAH patients returned to work. The rates of post-acute complications were headache (32.3%), chronic hydrocephalus requiring permanent ventriculoperitoneal shunting (VP shunt 25.4%) and epileptic seizures (9.5%). Despite patient’s and clinical characteristics, both presence of epilepsy and need for VP shunt were independently and negatively associated with a favorable functional outcome (epilepsy: adjusted odds ratio [aOR] (95% confidence interval [95% CI]): 0.125 [0.050–0.315]; VP shunt: 0.279 [0.132–0.588]; both p < 0.001) as well as with return to work (aOR [95% CI]: epilepsy 0.195 [0.065–0.584], p = 0.003; VP shunt 0.412 [0.188–0.903], p = 0.027). Multivariable analyses revealed presence of headache, VP shunt, or epilepsy to be significantly related to subjective health impairment (aOR [95% CI]: headache 0.248 [0.143–0.430]; epilepsy 0.223 [0.085–0.585]; VP shunt 0.434 [0.231–0.816]; all p < 0.01). Conclusions: Long-term complications occur frequently after SAH and are associated with an impairment of functional and social outcomes. Further studies are warranted to investigate if treatment strategies specifically targeting these complications, including preventive aspects, may improve the outcomes after SAH.

scholarly journals Long-term Follow-up of Two Cases of Latissimus Dorsi Transfer for Irreparable Rotator Cuff Tears

2010 ◽  
Vol 59 (4) ◽  
pp. 704-707
Author(s):  
Akihiko Kura ◽  
Yozo Shibata ◽  
Teruaki Izaki ◽  
Motoyuki Fujisawa ◽  
Tsuyoshi Shinoda ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Latissimus Dorsi ◽  
Rotator Cuff Tears ◽  
Latissimus Dorsi Transfer ◽  
Long Term Follow Up

scholarly journals Latissimus dorsi transposition for sequelae of obstetric palsy

2010 ◽  
pp. 248-255 ◽  
Author(s):  
Enrique Vergara- Amador
Keyword(s):  
Latissimus Dorsi ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Shoulder Abduction ◽  
Anterior Surface ◽  
Older Children ◽  
Subscapularis Muscle ◽  
Joint Deformity ◽  
Muscular Imbalance

Background: In obstetric palsy, limitation in the external abduction and rotation of the shoulder is the most frequent sequelae. Glenohumeral deformity is the result of muscular imbalance between the external and internal rotators. Releasing the contracted muscles and transferring the latissimus dorsi are the most common surgeries in this case. Patients and methods: We operated on 24 children between 4 and 8 years of age with obstetric palsy sequelae to elevate the subscapularis muscle off the anterior surface of the scapula posteriorly and transfer the latissimus dorsi. The patients received a minimum of 2 years of follow up. They were evaluated based on Mallet’s and Gilbert’s classifications. Results: All of the patients recovered within the above mentioned classifications. Out of 22 children evaluated via Mallet’s classification, all improved from 3 to 4 on that scale. With respect to Gilbert’s classification, 16 children improved one degree and 8 improved 2 degrees. All of the patients’ parents were satisfied with the results. Discussion: The benefit from releasing contracted muscles and muscle transfer to improve shoulder abduction in the sequelae of obstetric palsy has been amply reported in the literature. The results we had from elevating the subscapularis muscle off the anterior surface of the scapula and transferring the latissimus dorsi were good. Children who were difficult to classify based on the described scale were taken note of and some sub-classifications for Gilbert’s descriptions were proposed. Patients must be selected carefully. To transfer the latissimus dorsi, it is necessary to have good passive mobility in abduction, a minimum of 20º of external rotation and no joint deformities. When negative external rotation is found, the subscapularis muscle should be released. When there is glenohumeral joint deformity in older children, other methods are recommended, such as rotational humeral osteotomy.

Mid-term outcomes after reverse total shoulder arthroplasty with latissimus dorsi transfer

2021 ◽  
pp. 175857322199634
Author(s):  
Akshar V Patel ◽  
Douglas J Matijakovich ◽  
Robert L Brochin ◽  
Ryley K Zastrow ◽  
Bradford O Parsons ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Arthroplasty ◽  
Latissimus Dorsi ◽  
External Rotation ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
P Value ◽  
Latissimus Dorsi Transfer ◽  
Reverse Total Shoulder

Background Reverse total shoulder arthroplasty is a common treatment for patients with rotator cuff arthropathy who have failed a prior rotator cuff repair. Latissimus dorsi transfer can be performed simultaneously to reverse total shoulder arthroplasty for patients with preoperative external rotation deficiency. Current literature is limited with several studies providing functional and pain improvements at short-term follow-up; however, there is a deficit in data regarding mid-term outcomes. The purpose of this study was to evaluate the clinical and radiographic outcomes following reverse total shoulder arthroplasty with latissimus dorsi transfer with mid-term follow-up. We hypothesized significant improvement in external rotation and shoulder functionality for patients with preoperative external rotation lag. Methods We retrospectively reviewed patients who underwent reverse total shoulder arthroplasty with latissimus dorsi transfer. Preoperative and postoperative changes in range of motion were assessed. American Shoulder and Elbow Surgeon Score and the Simple Shoulder Test were used to evaluate changes in shoulder function while pain scores were assessed using the Visual Analog Scale (VAS). Radiographs were reviewed for rotator cuff arthropathy, fatty infiltration, scapular notching, baseplate loosening, and osteolysis. We reported frequency and mean ± standard deviation for categorical and continuous variables, respectively. Means were compared using the paired Student's t-test and proportions using the Chi-square test. Results Fifteen patients met the inclusion criteria. The mean age of the cohort was 71.7 ± 8.4 years (range 51.2–87.8 years) with a mean follow-up of 6.3 ± 4.1 years (range 1.0–14.5 years). Reverse total shoulder arthroplasty with latissimus dorsi transfer improved external rotation (−7 ± 21.3° to 38 ± 15.8°; p value = 0.001). There was no statistically significant difference regarding forward flexion (116.3 ± 45.4° to 133.7 ± 14.7°; p value = 0.17) and internal rotation (T12 to L2; p value = 0.57). The procedure led to an increase in American Shoulder and Elbow Surgeon Score scores (37 ± 19 to 62 ± 22; p = 0.005) and Simple Shoulder Test scores (2 ± 2 to 6 ± 3; p value = 0.001) with a significant reduction in Visual Analog Scale scores (5 ± 3 to 2 ± 3; p value = 0.022). The procedure corrected external rotation lag in 10 patients. Radiographically, rotator cuff arthropathy was found to be grade 3 in two patients, grade 4 A in four patients, grade 4B in eight patients, and grade 5 in one patient. On postoperative imaging, scapular notching was found in six patients (40%). Twelve patients had cortical humeral erosion at the site of the latissimus dorsi transfer. Only one patient experienced a shoulder-related complication which was aseptic baseplate loosening and required a revision reverse total shoulder arthroplasty with allograft. Conclusions In this study, patients undergoing reverse total shoulder arthroplasty with latissimus dorsi transfer experienced improvements in range of motion, functional scores, and pain at mid-term follow-up. The shoulder-related complication rate was low. Level of evidence: IV; Case series.

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