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Title: Reflected long head biceps tendon grafting : a biomechanical study on a new technique in reconstruction of paralyzed shoulder secondary to brachial plexus injury
Authors: Tang, Chun-yuen
Degree: M.Phil.
Issue Date: 1998
Abstract: A new tendon transfer technique is proposed for the reconstruction of the paralyzed shoulders secondary to Brachial Plexus Injury. In this tendon transfer, the long head of biceps tendons is utilized as a bridging tendon graft. It is reflected at the exit of the bicipital groove, passed through the deltoid and directed to the trapezius. This study evaluated the effect of this tendon transfer on the anterior, posterior and inferior stability of the reconstructed shoulder using cadaveric shoulder specimens. Joint kinematics, the moment arm of the transferred tendon, the glenohumeral joint contact area pattern were also investigated. Finally, the effect of the directions of the reflected long head of biceps(RLHB) on the anterior stability and the kinematics, and the possibility of using another donor muscle, the latissmus dorsi, for this tendon transfer procedure will also be explored. It was shown that the loading of the RLHB contributed significantly to anterior stability of the reconstructed shoulder in 90 degrees elevation in the scapula plane. For the post-operation conditions, the variation of the directions of RLHB had no statistically significant effect on the displacement in response to anterior loading. The RLHB tendon contributed to the posterior and inferior stability in low and middle elevations in the plane of scapula. The "Sub-Deltoid" and the "Through-Deltoid" tendon transfer procedures on the displacement of the humeral head in response to both posterior and inferior loading was not statistically significant different. In the kinematics study, the variation of the directions of RLHB had no statistically significant effect on the humeral elevation. With 3.7 kg force applied to the RLHB tendon directed to the upper part of the trapezius, the mean elevation was 63 degrees. Total tendon excursions of the RLHB after the Through-Deltoid and the Sub-Deltoid transfer technique were measured in three planes of elevation. In general, the moment arm study showed that the Though-Deltoid techniques yielded a larger moment than that of the Sub-Deltoid technique in three planes of elevation. Superior migrations of the humeral head contact during elevation were observed in the glenohumeral joint contact study. After the Through-Deltoid tendon transfer, the humeral head contact concentrated on the anterior central region. The anterior to posterior migration of the humeral head contact was documented after the Sub-Deltoid tendon transfer. No particular trend of contact pattern shift on the glenoid was observed in this study and the glenoid contact was found to be distributed uniformly in central inferior region. Deviations of contact pattern after the tendon transfer using the RLHB tendon were found in current study when compared to the quantitative data of the normal glenohumeral contact available in the literature. The result found in this study was encouraging in the stability, kinematics and moment arm testings, and it clearly documented the feasibility for clinical application of this tendon transfer approach.
Subjects: Shoulder -- Surgery
Tendons -- Surgery
Shoulder -- Wounds and injuries
Brachial plexus -- Wounds and injuries
Hong Kong Polytechnic University -- Dissertations
Pages: 113 leaves : ill. ; 30 cm
Appears in Collections:Thesis

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