Long head of the triceps muscle transfer for active elbow flexion in arthrogryposis

Abstract

Arthrogryposis is a condition characterized by symmetric, nonprogressive joint contractures and weak or absent musculature that is present at birth. The amyoplasia form is the most common, and in this group, the elbow is frequently involved, typically in an extension contracture bilaterally. Active elbow flexion is weak or absent, but active extension is spared. This elbow dysfunction poses a significant disability for affected children. Sensation and cognitive development is normal in children with arthrogryposis, and as a group they demonstrate a remarkable degree of adaptability to their deformities. The goal of any treatment is to facilitate the child's functional independence. This article describes the surgical technique of transfer of the long head of the triceps into the proximal ulna to provide active elbow flexion in children with arthrogryposis. The goal of the procedure is to reliably achieve antigravity active flexion while preserving active extension. It has the advantages of technical simplicity and minimal donor site morbidity. By adding this procedure to the existing options for treating this challenging condition, a surgeon is better able to tailor intervention to an individual child's strength and available donor muscles.