Skip to main content Skip to main navigation menu Skip to site footer

Functional outcome of a patient with upper type brachial plexus injury treated by Saha and Steindler procedure: a case report


Background: Upper type brachial plexus injury represents a major functional handicap. Secondary reconstruction was performed in neglected cases (>1 year without any attempt for reconstruction). The Saha procedure was commonly used for the reconstructive option for shoulder abduction, while the Steindler procedure for the reconstructive option for elbow flexion. We report a case in a patient with upper type brachial plexus injury treated by Saha and Steindler procedure.

Case Presentation: We report a case presentation of an upper type brachial plexus injury in a 50-year-old man with a history of trauma when the patient climbed the roof and fell down with his right shoulder and hit the floor first. The patient underwent Saha procedure for shoulder abduction and Steindler for elbow flexion. Both of these operations were successful. After a follow-up of six months, the patient can perform the daily living activity.

Conclusion: The Steindler procedure is one of the most common procedures and remains a powerful reconstructive option to restore elbow flexion. The Saha procedure was safe, easy, and significantly improved functional activity in a patient with upper-type brachial plexus injury.


  1. Beaty J, Canale S. Campbell W. Campbell’s Operative Orthopaedics. 10th ed. Philadelphia: Elsevier Mosby; 2013;1317-18.
  2. Patrick G, Marinello et al. Steindler Flexorplasty: A Description of Current Technique and Case Series. Tech Hand Surg 2019; 23: 165-169.
  3. Salama, Mahmoud & Omar, Usama. Role of Trapezius Transfer for Shoulder Reconstruction in Adult Traumatic Brachial Plexus Injuries: Literature Review. International Microsurgery Journal. 2018. doi:10.24983/scitemed.imj.2018.00058.
  4. Saleh R, Paturusi I, Sakti M, Pasallo P, Maulidiah Q, Guatama A. Evaluation of Elbow Function following Bipolar Latissimus Dorsi Flap in Late Partial Brachial Plexus Injury: A Case Report. Int. J. Surg. Open. 2019; 18-21. DOI:
  5. Rostoucher P, Alnot JY, Team C, Oberlin C. Tendon Transfers to Restore Elbow Flexion After Traumatic Paralysis of The Brachial Plexus in Adults. Int. Orthop. 1997; 22: 255-262. DOI:
  6. Monreal R, Gómez D, Osinaga G, Monreal E. Surgical options for brachial plexus injury in adults. OROAJ. 2017; 6(2): 46-50. DOI: 10.19080/OROAJ.2017.06.555687
  7. Rao PD, Rao RV, Srikanth R. Triceps to Biceps Transfer for Restoration of Elbow Flexion Following Upper Brachial Plexus Injury. Original Article. Indian J Plast Surg. 2017; 50: 35-42
  8. Chen WS. Restoration of Elbow Flexion by Modified Steindler Flexorplasty: Original Paper. Int Orthop. 2000; 24: 42-46. DOI:
  9. Monreal, R. Steindler flexorplasty to restore elbow flexion in C5-C6-C7 brachial plexus palsy type. J brachial plex peripher nerve inj. 2(01): e28-e32. DOI: 10.1186/1749-7221-2-15
  10. Monreal R, Paredes L, Diaz H, Leon P. Trapezius transfer to treat flail shoulder after brachial plexus palsy. J brachial plex peripher nerve inj. 2007; 2(01): e4-e7. DOI: 10.1186/1749-7221-2-2
  11. Severo AL, Maia PE, Lemos MB, Piluski PC, Lech OL, Fukushima WY. Transfer of the trapezius to the deltoid for treatment of shoulder instability after lesions of the brachial plexus. Surg. Sci. 2013; 4(10): 459.
  12. Singh AK, Karki D. Modified trapezius transfer technique for restoration of shoulder abduction in brachial plexus injury. Indian J Plast Surg. 2007; 40(1): 39-46.
  13. Eggers IM, Mennen U, Matime AM. Elbow flexorplasty: a comparison between latissimus dorsi transfer and Steindler flexorplasty. J. Hand Surg. Eur. Vol. 1992; 17(5): 522-525.
  14. Aziz W, Singer RM, Wolff TW: Transfer of the trapezius for flail shoulder after brachial plexus injury. J Bone Joint Surgery (Br). 1990; 72(4): 701-704.
  15. Rühmann O, Bohnsack M, Schmolke S, Carls J, Wirth CJ. Plattenarthrodese der Schulter. Besonderheiten bei Defekt- und Resektionszuständen [Shoulder arthrodesis with plate fixation. Special features in cases of resection and defects]. Z Orthop Ihre Grenzgeb. 2002;140(6):662-671. doi:10.1055/s-2002-36034.

How to Cite

Syam, A. D. P., Saleh, M. R., Rante, I. H., & Kusmawan, I. G. P. Y. (2021). Functional outcome of a patient with upper type brachial plexus injury treated by Saha and Steindler procedure: a case report. Bali Medical Journal, 10(3), 988–991.




Search Panel

Andi Dhedie Prasatia Syam
Google Scholar
BMJ Journal

M. Ruksal Saleh
Google Scholar
BMJ Journal

Indra Harianto Rante
Google Scholar
BMJ Journal

I Gusti Putu Yoga Kusmawan
Google Scholar
BMJ Journal