Reconstruction of shoulder function using a reflected long head biceps: a moment arm study

A tendon transfer technique is proposed for the reconstruction of the paralyzed shoulders secondary to brachial plexus injury. This innovative technique does not require bone-to-bone or tendon to-bone fixation, and attempts to overcome other clinical limitations such as those due to insufficient length of donor muscle. The approach is referred to as the reflected long head biceps (RLHB) technique. The long head of biceps tendons is utilized as a bridging tendon graft. Two surgical alternatives, namely the through-deltoid (TD) pathway and the sub-deltoid (SD) pathway, were studied. The moment arms of the transferred tendons were assessed and reported. The TD technique yielded a larger moment than the SD technique. In the plane 30° anterior to the scapular plane, the average moment arms were 3.8 cm TD and 3.0 cm SD at zero elevation. Such differences tended to further widen with increasing elevation. At 80° elevation, the moment arms became 3.2 cm TD and 1.2 cm SD. The results supported the clinical feasibility of this RLHB tendon transfer approach.