Latissimus dorsi and teres major transfer to rotator cuff for Erbʹs palsy

During a 20-year period the authors operated on 56 patients with Erbʹs palsy to create active external rotation of the shoulder. Thirty-five patients had a follow-up period longer than 2 years (average 5 years), which allowed comparison with preoperative motion and strength. Preoperative passive external rotation averaged 5°, whereas active abduction averaged 74°. Preoperative external rotation strength was less than grade 2, whereas preoperative abduction strength was grade 2 or 3 in 33 of the 35 patients. Postoperative active external rotation averaged 31° with only two recurrent internal rotation contractures. Postoperative active abduction averaged 120°. Postoperative strength in external rotation increased in 29 of the 35 patients, with abduction strength increasing one or more grades in 13 of the 35 patients. Four complications occurred. Three patients continued to lose external rotation and required further surgical procedures, and a fourth had a superficial infection. This procedure compares well with the classic transfers to the proximal humerus in that it provides active external rotation in most cases and in some increases shoulder abduction strength.