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Lower Trapezius Tendon Transfer

What Is a Lower Trapezius Tendon Transfer?

A lower trapezius tendon transfer (LTT) is a surgical procedure performed to improve shoulder strength, stability, and function when several of the major rotator cuff tendons—specifically the supraspinatus and infraspinatus—are torn and cannot be repaired.

The lower trapezius muscle is located on the upper back and normally helps pull the shoulder blade down and back. In this procedure, a portion of that tendon is detached and transferred to the previous rotator cuff insertion to compensate for the damaged rotator cuff. A graft (usually donor achilles) is used to extend the tendon so it can reach the new attachment site.

Who is a Good Candidate?

This surgery is usually recommended when:

  • You have amassive and irreparable rotator cuff tear in the back of the shoulder (posterosuperior cuff).
    • This often occurs in patients who have had a previous traumatic rotator cuff tear and failed one or more attempted repairs or had never undergone surgery.
  • You aretoo young or active to be a good candidate for a reverse shoulder replacement.
  • This procedure is typically reserved for younger, healthy, and highly active patients who, for some reason, have suffered an irreparable massive rotator cuff tear.

Who Is Not a Good Candidate?

Lower trapezius tendon transfer may not be suitable if:

  • You have evidence of arthritis of the shoulder joint on x-ray or MRI
  • You are unable to tolerate a lengthy rehabilitation

Goals of the Surgery

This surgery aims to:

  • Reduce shoulder pain
  • Improve strength and motion, especially external rotation and forward flexion
  • Improve ability to perform daily activities, work tasks, and sports

What to Expect After Surgery

Recovery requires patience and commitment to a structured rehabilitation program. The tendon needs time to heal in its new position and retrain the brain and shoulder muscles for new movement patterns.

Recovery Timeline

Below is a typical recovery course

Phase 1: Protection Phase (0–6 Weeks After Surgery)

Goals:

  • Protect the repaired tendon

What to Expect:

  • Arm is supported in an external rotation arc brace nearly full-time
  • Avoid lifting, reaching, pushing, or pulling with the shoulder
  • Gentle elbow, wrist, and hand motion is allowed

Therapy Focus:

  • Hand, wrist, and elbow movement
  • Gentle passive shoulder range of motion, often guided by a therapist

Phase 2: Early Motion (6–12 Weeks)

Goals:

  • Begin restoring shoulder movement
  • Continue protecting the surgical repair

What to Expect:

  • Brace is discontinued
  • Therapy progresses to:
    • Passive and active-assisted range of motion
    • Gentle stretching
    • Scapular (shoulder blade) exercises

Restrictions:

  • Still no strengthening of the shoulder
  • No lifting more than a small object (like a coffee cup)

Phase 3: Strengthening Phase (3–6 Months)

Goals:

  • Re-educate the transferred tendon to function like the rotator cuff muscles
  • Improve strength and control of shoulder blade and shoulder muscles
  • Build stable shoulder mechanics for daily activities

Therapy Focus:

  • Rotator cuff strengthening
  • Scapular stabilization
  • Functional patterns that teach the new tendon to work in its new role

Strength gains are gradual, and coordination training is especially important.

Phase 4: Functional Return (6–12 Months)

Goals:

  • Regain strength and endurance needed for work, hobbies, and sports

Most patients return to:

  • Regular daily activities by 3–6 months
  • Light sports between 6–9 months
  • Higher-demand activities (like gym and overhead sports) after 9–12 months

Expected Outcomes

Most patients experience:

  • Significant pain relief
  • Improved strength, especially in external rotation
  • Better shoulder control and function

However:

  • Full strength may not return
  • Patients may experience persistent pain
  • Arthritis may still develop later in life. If so, other procedures—such as a reverse shoulder replacement—may still be options

Commitment Matters

This procedure requires a long rehabilitation period and high patient motivation. Success depends heavily on:

  • Following external rotation arc brace protection x6 weeks
  • Attending physical therapy
  • Performing exercises as prescribed
  • Allowing the tendon to fully heal before returning to heavy use

 

I hope this provides some useful information regarding the procedure and recovery. Please never hesitate to schedule a consultation with Dr. Huff if you think you may benefit from this procedure.

Best,

Scott Huff, MD