Lower Trapezius Transfer

⚙️What This Procedure Involves

Through a posterior incision, the lower trapezius tendon is harvested with a strip of the scapular spine periosteum. Because the native tendon is short, an Achilles tendon allograft is used to extend it. The graft-tendon construct is passed subcutaneously and attached to the greater tuberosity (rotator cuff footprint) using suture anchors. The lower trapezius then functions as an external rotator with a more anatomical direction of pull than the latissimus dorsi. The operation takes two to two and a half hours.

💡Why It May Be Recommended

Lower trapezius transfer is increasingly preferred over latissimus dorsi transfer for external rotation deficit from irreparable posterosuperior cuff tears, because its vector of pull more closely matches the infraspinatus — the muscle it replaces. It is particularly effective when combined with an intact or repairable subscapularis.

⚖️Non-Operative Alternatives

Anterior deltoid rehabilitation, latissimus dorsi transfer (alternative tendon transfer), SCR, partial cuff repair, and reverse shoulder replacement.

📋Preparing for Surgery

MRI confirming irreparable posterosuperior cuff tear with intact subscapularis. CT to assess arthropathy. EMG to confirm lower trapezius function. Assessment of external rotation lag and hornblower's sign.

✅Expected Benefits

Restoration of active external rotation. Early published results show significant improvement in external rotation strength and patient satisfaction in approximately 80–85% of cases.

⚠️Common Risks

• Prolonged rehabilitationExpected

  Six to twelve months for full recovery.

• Posterior wound discomfortCommon

  From the harvest site.

• Donor site weaknessCommon

  Some loss of lower trapezius function — rarely noticed.

🔴Less Common but Serious Risks

• Transfer failureUncommon

  The graft-tendon construct may not heal to the tuberosity. Risk approximately 10–15%.

• Allograft complicationsUncommon

  Immune reaction, infection, or failure of the extender graft.

• Spinal accessory nerve injuryRare

  The nerve supplying the trapezius must be preserved.

• InfectionRare

  Wound or deep infection.

💉Anaesthetic Considerations

General anaesthesia. Lateral decubitus position.

🏃Recovery and Rehabilitation

Sling and abduction pillow for six weeks. No active internal rotation for six weeks (protects the transfer). Passive external rotation from two weeks. Active external rotation from six weeks. Motor re-education: learning to use the lower trapezius for external rotation. Strengthening from three months. Full recovery six to twelve months.

📅Follow-Up

Reviews at two weeks, six weeks, three months, and six months.

❓Frequently Asked Questions