Bidirectional double muscle transfer to restore shoulder abduction and external rotation in late obstetric brachial plexus injuries

Background: Medial rotation contracture represents the most persistent and frequent late deformity of the shoulder, in obstetric brachial plexus injuries (OBPIs).Many techniques have been tried to solve this problem. Aim: This study aimsto enhance shoulder abduction and outward rotation by performing an ordinary single direction muscle transfer (SDMT) or bidirectional double muscle transfer (BDMT) around the shoulder. Methods: 40 patients: 21 male and 19 female, their age ranged from 2 to10 years complaining of weak abductors and external rotation of the shoulder due to OBPIs. They were divided into two groups according to the performed operation: group 1(17 patients) operated withBDMT and group 2 (23 patients) operated with SDMT. Results: There was significant postoperative improvement in shoulder abduction, external rotation and flexion in both procedure “BDMT and SDMT”. In addition, the young age gives better results as there are negative correlations between patient age and degree of shoulder functions improvement in both groups.Moreover, BDMT procedure had significant higher degree of improvement in shoulder abduction and external rotation than SDMT procedure. Conclusion: BDMT is recommended as an optimal option to improve both abduction and external rotation of shoulder in late OBPIs.