Modified Saha Procedure for Chronic Paralytic Shoulder After Reverse Shoulder Arthroplasty Complicated With Brachial Plexus Injury

Nerve injuries after reverse total shoulder arthroplasty (rTSA) are rare, and fortunately, most patients recover without long- term sequelae. However, irreversible deltoid paralysis due to brachial plexus or axillary nerve injury is devastating, as the deltoid is the main force of movement of the humerus after rTSA. Denervation of the deltoid results in weakness in abduction, forward flexion, and elevation, as well as varying degrees of chronic pain and shoulder instability. Treatment options for chronic deltoid denervation after axillary nerve or brachial plexus injuries are limited, since nerve repair, graft, or transfer procedures are ineffective. Trapezius tendon transfers, including the Saha technique, have been used to treat chronic deltoid weakness in native shoulders. Here, the authors present a modified Saha technique to improve shoulder motion and stability in patients with chronic deltoid paralysis following rTSA. (Journal of Surgical Orthopaedic Advances 32(4):276-280, 2023)

Key words: Saha procedure, trapezius transfer, reverse shoulder arthroplasty, deltoid dysfunction, brachial plexus injury, axillary nerve injury