Arthroscopic-assisted Lower Trapezius Tendon Transfer

This surgery is recommended for people who have massive and “irreparable” rotator cuff tears that cannot be fixed with standard repair. These tears usually cause difficulty lifting the arm or rotating it outward, which makes everyday tasks like combing hair, reaching overhead, or putting on a jacket very difficult. Left untreated the problem will progress to arthritic changes.

Patients who are still active, want to maintain shoulder function, and are not good candidates for shoulder replacement may benefit the most. The shoulder joint itself needs to be relatively healthy, and the front tendon (subscapularis) and deltoid muscle should be working properly to support the transfer.

At your first appointment, Dr. Kaplan will take time to learn about your symptoms, daily challenges, and goals. He will perform a detailed shoulder exam to check motion, strength, and how your shoulder blade moves. X-rays and an MRI are usually ordered to understand the extent of the tear, muscle quality, and overall shoulder health. If you have already tried non-surgical options like physical therapy, injections, or medications without success, Dr. Kaplan will explain how this surgery may help. You will also learn about what recovery looks like, what results to expect, and any risks to be aware of before deciding.

On the day of surgery, anesthesia is used so you are comfortable. Dr. Kaplan begins with small incisions around the shoulder, using a tiny camera (an arthroscope) to see inside the joint and prepare the bone where the new tendon will attach. He may also clean out inflamed tissue or repair other small tears.

Through a separate incision along the shoulder blade, the lower trapezius tendon is carefully harvested and prepared for transfer. Because this tendon is not long enough to reach the shoulder on its own, a graft (often a donor tendon) is sewn to it. This graft acts as a bridge, extending the tendon to the top of the arm bone. Using anchors and sutures, Dr. Kaplan secures the graft in place. Once the tendon is properly positioned, the incisions are closed, and the arm is placed in a protective brace.

Recovery takes time and is just as important as the surgery itself. For the first six weeks, your arm will be supported in a special brace that keeps it safe while the tendon heals. You can still move your hand, wrist, and elbow, but the shoulder itself is protected.

After about six weeks, physical therapy begins to slowly restore motion. Therapists guide you through gentle stretches at first, then gradually help you regain strength. Around three months after surgery, more active strengthening begins. Most patients return to light daily activities by this point, though heavier tasks, sports, or overhead movements may take longer. Full recovery can take 9 to 12 months as the transferred tendon learns to work like the rotator cuff.

The main goals of this surgery are to reduce pain, improve arm motion, and restore strength—especially for tasks that involve rotating the arm outward or reaching away from the body. Many patients notice a big difference in daily activities such as dressing, reaching overhead, or using the arm for work and hobbies. While the procedure does not usually restore the shoulder to its original strength, it often provides meaningful improvement in function and quality of life.

As with any surgery there are common risks including infection, stiffness, nerve injury, or problems with the graft. Dr. Kaplan takes steps to minimize these risks and will discuss them with you during your visit. For the right patient, arthroscopic-assisted lower trapezius tendon transfer offers a way to regain motion and avoid more invasive surgeries like shoulder replacement.