Rehabilitation challenges and strategies following arthroscopic-assisted lower trapezius tendon transfer: A case report with postoperative wound complication

Abstract

Introduction: Massive and irreparable rotator cuff tears in young patients represent a clinical challenge. Lower trapezius tendon (LTT) transfer has been proposed as an alternative to reverse shoulder arthroplasty, but there is a lack of data regarding associated rehabilitation protocols, especially in the presence of postoperative complications. Objective: To report the clinical course and rehabilitation challenges following arthroscopically assisted LTT in a patient with postoperative wound complication. Methods: This was a retrospective case report, following the CAse REports (CARE) guidelines, of a 51-year-old patient with an irreparable rotator cuff tear who underwent LTT with an Achilles tendon allograft. The rehabilitation protocol was structured into three phases and adapted according to wound healing and functional progression. Objective assessments included isokinetic dynamometry. Results: A superficial wound dehiscence occurred between weeks 8 and 10, delaying the introduction of certain exercises. Nevertheless, the patient achieved full, pain-free range of motion and partial functional improvement. Dynamometry revealed strength deficits of 66% in external rotation and 28% in abduction, requiring prolonged follow-up. Recovery was self-rated by the patient at 75% after six months and 38 physical therapy sessions. Conclusion: Despite complications, LTT can result in meaningful functional improvement when combined with an individualized rehabilitation program. Managing patient expectations and ensuring long-term follow-up are essential for therapeutic success.