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Equivalent outcomes found with direct, indirect transfers of long thoracic nerve palsy
Recently published study findings showed equivalent outcomes in both direct and indirect transfers for the treatment of long thoracic nerve palsy with split pectoralis major.
Researchers performed a three-tiered study by conducting an anonymous survey of American Shoulder and Elbow Surgeon (ASES) members, searching for literature published from January 1970 to January 2014 that reported on clinical outcome after pectoralis transfer for long thoracic nerve palsy and performing a study that included patients who had long thoracic nerve palsy and underwent transfer of the sternal head of the pectoralis major with or without use of tibialis anterior of Achilles allograft.
Of the 112 ASES members who responded to the survey, the researchers found no consensus regarding the length of nonoperative treatment necessary before tendon transfer, whether a split or whole pectoralis tendon should be used, transfer technique or graft type. Results showed surgeons who were less experienced were just as likely as experienced surgeons to use whole vs. split tendon transfer or to prefer allograft over autograft. The researchers also found the direct transfer technique was more likely to be used by surgeons with less experience vs. surgeons who had been in practice for more years, who were more likely to use indirect transfer with graft interposition. Split transfer with the sternal head as the donor tendon, as well as indirect transfer technique with graft interposition, was used more often by surgeons who had seen more cases in their careers.
Peter Chalmers
The researchers included 10 studies in the systematic review with 131 shoulders in 130 patients, of which, 27 shoulders received direct transfer and 104 shoulders received indirect transfer. Results showed patients were significantly more likely to develop recurrent medial scapular winging and had significantly lower postoperative active forward elevation and ASES scores if they underwent indirect transfer.
Finally, for the third tier of the study, 24 patients met inclusion criteria. A tibialis anterior allograft and an indirect transfer was used in 14 cases and an Achilles allograft tendon and a direct transfer was used in 10 cases.
Overall, results showed no significant postoperative differences between the indirect and direct cohorts in rate or return to full-duty work, return to play, resolution of scapular winging, complications, VAS scores, Simple Shoulder Test (SST) scores, ASES scores or range of motion. The researchers also found no significant difference between groups in change in VAS, SST or ASES scores preoperatively and postoperatively.
Compared with preoperative scores, VAS, SST and ASES scores significantly improved postoperatively within the overall cohort, according to study results. – by Casey Tingle
Disclosure: The researchers report no relevant financial disclosures.