Lower Trapezius Tendon Transfer

The Goal

Dr. Kevin Wall provides specialized, fellowship-trained surgical treatment for Lower Trapezius Tendon Transfer to restore function and relieve pain for patients in Richmond, VA, and the surrounding Central Virginia communities. The goal of this advanced reconstruction is to restore the ability to lift and externally rotate the arm in patients with a massive, irreparable tear of the posterosuperior rotator cuff (supraspinatus and infraspinatus). When these tendons are retracted and atrophied, patients often develop "pseudoparalysis"—they have the nerve function to move, but the mechanical engine (the rotator cuff) is broken. For younger, active patients who have an irreparable rotator cuff tear and wish to avoid a shoulder replacement, transferring the lower trapezius muscle creates a new "external rotator" that restores the force couple of the shoulder, allowing you to lift your arm again without the restrictions of an artificial joint. Not everyone is a candidate for a tendon transfer however, and a thorough evaluation and discussion with Dr. Wall is important to determine if this option is best for you.

This page is designed to educate you specifically about this procedure. Additional information that generally applies to most of Dr. Wall’s surgeries can be found on these pages:

The Procedure

  • The Approach: This is a hybrid procedure utilizing an arthroscopic-assisted technique. Minimally invasive portals are used around the shoulder joint for fixation, while a small incision is made on the back, over the shoulderblade, to harvest the lower trapezius tendon.

  • Tendon Harvest: The lower trapezius tendon is identified and mobilized. Because the native tendon is not long enough to reach the top of the humerus, Dr. Wall extends its reach using a robust Achilles tendon allograft.

  • The Transfer: The graft is passed carefully through muscular layers to the top of the humerus.

  • Fixation: Using arthroscopic visualization, the graft is securely anchored to the footprint of the torn rotator cuff (greater tuberosity) using heavy-duty anchors. This recreates the line of pull necessary for external rotation. If any residual rotator cuff can be partially repaired, this is done. If any other procedures are required such as debridement or biceps tenodesis, these are also performed.

Post-Op Protocol

  • Immobilization (Phase 1: 0–8 weeks): Strict protection is critical. You will be immobilized in a Gunslinger Brace 24 hours a day to take all tension off the healing transfer. No shoulder motion is permitted but you may move your elbow, wrist, and hand.

  • Phase 2 (8–16 weeks): The Gunslinger is removed and formal PT is started. You will transition to a sling for 1 week and then wean to no support. Therapy focuses on progressive passive and active-assisted range of motion (PROM/AAROM) and aqua therapy. No stretching or strengthening is allowed yet.

  • Phase 3 (16–24 weeks): Full active range of motion (AROM) is permitted. Progressive stretching and strengthening begin once motion is established.

  • Phase 4 (24 weeks+): You will progress to full strengthening and return to activities as tolerated.

When to Seek Care

You should schedule a consultation if:

  • You have a massive rotator cuff tear and have been told it is "irreparable" or "too old to fix."

  • You are under 65 and want to avoid a Reverse Shoulder Replacement.

  • You cannot lift your arm above shoulder height or rotate your hand outward (e.g., to reach a seatbelt or brush your hair).