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Triple Tendon Transfer (Eden-Lange Procedure)

Triple Tendon Transfer (Eden-Lange Procedure)

For Spinal Accessory Nerve Palsy

 

What is Spinal Accessory Nerve Palsy?

The spinal accessory nerve controls an important shoulder muscle called the trapezius, which helps stabilize and rotate the shoulder blade (scapula).

If this nerve is injured—often from:

  • Neck or shoulder surgery
  • Trauma
  • Stretch or traction injury

—the trapezius muscle becomes weak or paralyzed and can no longer hold the shoulder blade in its normal position.

Patients may experience:

  • Drooping of the shoulder
  • Pain around the shoulder blade
  • Difficulty lifting the arm
  • Limited endurance or fatigue
  • Visible “scapular winging” (shoulder blade sticking out)

Some patients improve with physical therapy, but when weakness is permanent, surgery may help restore function.

What is the Triple Tendon Transfer (Eden-Lange Procedure)?

The Eden-Lange procedure is a surgical technique that repositions three shoulder muscles to take over the job of the injured trapezius.

In the surgery:

  • Three muscles normally attached closer to the ribs are carefully detached:
    • Levator scapulae
    • Rhomboid major
    • Rhomboid minor
  • These muscles are moved and reattached to thescapular spine (upper border of the shoulder blade).
  • Their new position allows them to function like the trapezius, helping stabilize the shoulder blade and improving arm movement.

This surgery does not repair the nerve, but instead rebalances the shoulder using the body’s own muscles.

Who Is a Good Candidate?

You may be recommended for this surgery if:

  • You havetrapezius paralysis that has not recovered after 9–18 months.
  • You have persistent:
    • Shoulder drooping
    • Pain or fatigue
    • Difficulty with overhead movement
    • Scapular winging
  • Extensive physical therapy has not been successful.
  • You are willing to commit to the rehabilitation program.

Patients should still have good function of the levator scapulae and rhomboid muscles, as they will become the new stabilizers.

What Are the Benefits?

The Eden-Lange procedure can lead to:

  • Improved shoulder stability
  • Reduced scapular winging
  • Better arm elevation and endurance
  • Improved appearance of shoulder posture
  • Reduced pain

Possible Risks and Complications

As with any surgery, risks may include:

  • Pain and stiffness
  • Infection
  • Weakness or limited motion
  • Failure of the tendon transfer to heal
  • Persistent winging or discomfort

Serious complications are uncommon, and most patients do well with structured rehabilitation.

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 sling with bolster 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:

  • Sling 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 forward flexion
  • Better shoulder control and function

However:

  • Full strength may not return
  • Patients may experience some persistent pain and scapular winging

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