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. 2025 Jun 19;20(1):e41-e46.
doi: 10.1055/a-2618-3151. eCollection 2025 Jan.

Coracohumeral Ligament Sectioning in Teres Major versus Latissimus Dorsi Tendon Transfer in Brachial Plexus Birth Palsy

Javier Gutierrez-Pereira  1 , Antonio Garcia-Lopez  1
Affiliations

Coracohumeral Ligament Sectioning in Teres Major versus Latissimus Dorsi Tendon Transfer in Brachial Plexus Birth Palsy

Javier Gutierrez-Pereira et al. J Brachial Plex Peripher Nerve Inj. .

Abstract

Background: The latissimus dorsi tendon transfer (LDTT) to the supraspinatus tendon is a common procedure for restoring shoulder abduction and external rotation in upper root brachial plexus lesions. However, its association with scapular retraction often limits shoulder abduction.

Methods: This retrospective study compared the functional outcomes of teres major tendon transfer (TMTT) combined with anterior coracohumeral ligament release (CHLR) versus LDTT. Patients who underwent surgery at our center between January 2012 and December 2022 were included, with a mean follow-up of 38 months. Outcomes were assessed using a range of motion and the Mallet scale.

Results: A total of 40 patients were included, with 20 undergoing TMTT with CHLR and 20 undergoing LDTT. The overall mean age was 3.9 years (range: 2.7-4.8), with mean ages of 3.4 years (range: 2.2-5.2) in the LDTT group and 4.1 years (range: 2.8-5.2) in the TMTT with the CHLR group. The TMTT with CHLR group achieved mean gains of +77 degrees in active abduction, +44 degrees in active external rotation, and +46 degrees in passive external rotation. In comparison, the LDTT group demonstrated gains of +46, +27, and +24 degrees, respectively, for the same parameters.

Conclusion: TMTT combined with anterior CHLR significantly improves shoulder abduction and external rotation in patients with Brachial plexus birth injury, particularly those with internal rotation contractures. This technique offers superior functional outcomes compared to LDTT, suggesting a more effective therapeutic alternative.

Level of evidence: IV, retrospective comparative study.

Keywords: brachial plexus birth injury; coracohumeral ligament; latissimus dorsi; tendon transfer; teres major.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Author's illustrations. ( A ) Deltopectoral approach to the shoulder centered on the coracoid process. ( B ) The red dashed line indicates the release of the anterior coracohumeral ligament. ( C ) Surgical image showing the anterior coracohumeral ligament ready for release.
Fig. 2
Fig. 2
Author's illustrations of the surgical technique, posterior anatomical view of the humeral region. ( A ) The teres major tendon is inserted together with the latissimus dorsi tendon into the intertubercular groove of the humerus. ( B ) Depiction of the transfer of the teres major tendon to the supraspinatus muscle. ( C ) Surgical image of the final result of the transfer.
Fig. 3
Fig. 3
Arm and trunk immobilization in abduction and external rotation.
See this image and copyright information in PMC

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