About This Procedure
A lower trapezius tendon transfer is a specialized procedure for patients whose rotator cuff tear cannot be repaired. When rotator cuff tendons become too damaged, shortened, or weakened for a reliable repair, a different approach is needed. This procedure repositions a healthy muscle — the lower trapezius, located in the upper back — to take over some of the lost rotator cuff function.
Dr. Jay Levin performs lower trapezius tendon transfers at Duke Health in Durham, serving patients from Cary, Chapel Hill, Raleigh, and across North Carolina who are seeking an alternative to shoulder replacement for irreparable rotator cuff tears.
This procedure may be recommended when the rotator cuff tear is irreparable, prior rotator cuff surgery has failed, shoulder arthritis is minimal or absent, and the patient is relatively young or active. The goal is to preserve the native shoulder joint and avoid or delay shoulder replacement.
How the Procedure Works
The lower trapezius muscle normally helps stabilize and move the shoulder blade. Its natural direction of pull is similar to the torn rotator cuff tendons that control external rotation and shoulder stability.
During surgery, the lower trapezius tendon is released from its original attachment. A tendon graft — often donor tissue — is used to connect and lengthen the tendon so it can reach the shoulder. The graft is attached to the upper arm bone where the rotator cuff tendon is no longer functional.
Over time, with healing and physical therapy, the transferred tendon is retrained to help the shoulder move and function more effectively.
Recovery
Recovery after a lower trapezius transfer is long and demanding, often lasting several months. Strict adherence to sling use and physical therapy is critical.
Phases of recovery: For the first 6 weeks, strict sling use is required at all times — no active shoulder motion. From 6–12 weeks, passive then active-assisted motion is gradually introduced as the transferred tendon begins retraining. From 3–6 months, progressive strengthening begins with return to daily activities. Full recovery can take up to 12 months.
Important expectations:
- Improvement is gradual, not immediate
- Physical therapy is essential to success
- The goal is improvement, not perfection
- Some residual symptoms or limitations may persist
Risks
As with any surgery, this procedure carries risks including infection, bleeding, nerve or blood vessel injury, stiffness, persistent pain, failure of the tendon to heal or function as intended, stretching or weakening of the transferred tendon over time, incomplete improvement in strength or motion, and need for additional surgery.
Alternatives
Alternatives to lower trapezius transfer include continued nonsurgical treatment (activity modification, physical therapy, medications, injections), partial rotator cuff repair, other tendon transfer procedures, and reverse total shoulder arthroplasty. Dr. Levin will review your imaging, examination findings, and goals to recommend the best approach.