Introduction

Rotator cuff tears (RCTs) are among the most common shoulder disorders. The incidence of RCT pathology increases with age; however, many patients are asymptomatic. RCTs often progress over time; they may become irreparable because of tendon retraction to the glenoid edge, marked fatty infiltration, and compromise of two or more tendons. Posterosuperior RCTs involve the supraspinatus; infraspinatus; and, in some patients, the teres minor. Many patients with an irreparable RCT respond favorably to nonsurgical treatment; however, surgical treatment should be considered in patients in whom nonsurgical treatment fails to improve pain. Surgical repair of irreparable RCTs results in failed healing in a high percentage of patients. In younger, more active patients with an irreparable RCT, tendon transfer is a good treatment option. The most commonly used tendon transfer for the management of irreparable posterosuperior RCTs is a latissimus dorsi transfer with or without the teres major; however, the lower trapezius also is an option because a trapezius transfer has a more direct line of pull to improve external rotation.

Purpose

This video demonstrates the gross anatomy of the posterosuperior shoulder, with an emphasis on the muscular anatomy. Lower trapezius transfer for the management of a posterosuperior RCT in a cadaver model and in two patients is shown. In addition, the results of our patients who have undergone lower trapezius transfer are reported.

Method

This video demonstrates lower trapezius transfer in a cadaver model and in two patients, one of whom underwent an open surgical approach and one of whom underwent arthroscopic-assisted surgery. Eight patients with an irreparable posterosuperior RCT who underwent lower trapezius transfer augmented with the use of tendon allograft were retrospectively reviewed. RCTs were confirmed via MRI. One patient underwent an all-open approach (lower trapezius harvest and intra-articular shoulder). Seven patients underwent arthroscopic-assisted surgery (intra-articular shoulder). Outcomes regarding pain, flexion, abduction, elevation, and external rotation were assessed at a mean follow-up of 14 months (range, 4 to 24 months).

Results

A total of eight patients (seven men, one woman) with a mean age of 55.8 years (range, 40 to 66 years; standard deviation ±6.98 years) were included in the study. All the patients had an irreparable posterosuperior RCT, and six of the patients had an external rotation lag. Mean external rotation improved from 28° preoperatively (range, 10° to 60°; standard deviation ±15.79°) to 60° at final follow-up (range, 50° to 80°; standard deviation ±8.66°). Mean anterior flexion improved from 78° preoperatively (range, 45° to 100°; standard deviation ±17.32° to 110° at final follow-up (range, 80° to 130°). The external rotation lag disappeared in all the patients who had an external rotation lag preoperatively. Considerable improvements in shoulder pain and function were reported in seven patients (87.5%) at final follow-up.

Conclusion

Lower trapezius transfer is an effective treatment option for patients with an irreparable posterosuperior RCT, resulting in improvements in function and shoulder pain.