Modified Hoffer procedure for children with Erb's palsy

ABSTRACT

The Hoffer technique in which the tendons of the latissimus dorsi and teres major are transferred to the rotataor cuff-posterior to the long head of the triceps - has been reported to result in significant improvement in both external rotation and abduction of the shoulder. During an 18-month period, 13 children with obstetric brachial plexus palsy [C5-C6 pattern of involvement] underwent a stimultaneous subscrapularis recession and transfer of the tendons of the latissimus dorsi and teres major muscles to the rotator cuff through a single posterior incision. The age at time of surgery ranged from 4-8 [average 5.5] years. Follow up ranged from 13-31 [average 18] months. All patients improved following surgery. The average gain in external rotation was 51.5° and in abduction was 61.6°. This study further emphasizes the results of previous authors regarding improvement of shoulder external rotation and abduction following the Hoffer procedure. A modification of the original procedure is described allowing correction of the internal rotation contracture and tendon transfer through a single incision