A tendon transfer surgery in which a portion of the back muscle (latissimus dorsi) is moved to the head of the humerus to restore motion and strength in irreparable large rotator cuff tears.
Indication
- Irreparable large posterior-superior rotator cuff tears (especially involving the infraspinatus and supraspinatus)
- Painful shoulder dysfunction with limited active external rotation
- Patients in whom conservative treatment (physical therapy, medication, injections) and standard cuff repair are not suitable
- Young and active patients with high functional expectations who are not candidates for shoulder arthroplasty
- Patients without pseudoparalysis and with an intact deltoid muscle
Preparation
- No food or drink for 8 hours before the procedure (for anesthesia)
- Blood thinners are adjusted with physician approval
- Preoperative blood tests, ECG, and shoulder MRI/CT images are reviewed
- Smoking cessation at least 2-4 weeks before surgery is recommended
- Approval from the relevant specialty is obtained for chronic conditions
How it's performed
- Vital signs are continuously monitored and an IV line is placed
- General anesthesia and, when needed, regional nerve block are administered by the anesthesiologist
- The patient is positioned in a lateral or supine position, and the skin is sterilized
- A portion of the latissimus dorsi muscle (with its tendon) in the back is carefully released
- It is passed through an incision on the posterior shoulder and fixed in place of the damaged cuff to provide strength
- Tissue tension is checked, the incisions are closed in layers, and the shoulder is placed in a sling
Post-procedure
- Hospital stay is generally 2-4 days
- Shoulder sling for the first 4-6 weeks; passive range-of-motion exercises are started in a controlled manner
- At 6-12 weeks, active assisted exercises and gradual strengthening
- Substantial return to daily activities between 3-6 months; sports activities at 6-12 months
- Regular physical therapy sessions and physician follow-ups (at 2, 6, and 12 months)
Risks
- Infection and wound healing problems
- Hematoma (bleeding under the skin) and transient swelling
- Nerve injury — particularly to the thoracodorsal and axillary nerve regions (rare)
- Loss of tension in the transferred tendon, rupture, or less strength gain than expected
- Anesthesia reactions and persistent restriction of shoulder motion
FAQ
Which patients are suitable for this surgery?
It is considered for patients with an irreparable posterior-superior cuff tear, an intact deltoid muscle, who do not yet require shoulder arthroplasty, and who have loss of external rotation and active motion. The decision is based on examination, MRI, and patient expectations.
How long does recovery take?
Full recovery takes 6-12 months. Shoulder sling protection is needed for the first 4-6 weeks, followed by gradual physical therapy. Patient compliance directly affects the outcome.
Will I regain full prior shoulder motion?
Most patients experience significant pain reduction and meaningful improvement in arm elevation and external rotation. However, fully normal shoulder motion may not be achieved in every patient; individual outcomes vary.
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