Restoration of Elbow Flexion by Pectoralis Major and Minor Transfer in a Case with Arthrogryposis Multiplex Congenita.

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Restoration of elbow flexion by pectoralis major and minor transfer after the method of Tsai was done in a 5-year-old boy with arthrogryposis multiplex congenita. The patient could neither feed himself nor wash his face due to severe extension contracture of the elbow (Rt. 0/50°, Lt. 0/35°). Surgical procedures to the right elbow included Z-lengthening of short triceps tendon, posterior capsulotomy of the elbow joint and shortening of the radius to reduce the anteriorly dislocated radius head which struck against the capitellum in more than 90° elbow flexion. There was no biceps, brachialis, or brachioradialis in the upper arm. Pectoralis major and minor transfer was used for restoration of elbow flexion. His right arm was immobilized at 100° in a cast for 3 weeks. A rubber band splint was then applied to assist active elbow flexion for another 4 weeks.Nine months after surgery, the active range of motion of the right elbow was -55° extension with fair strength in manual muscle testing (MMT) and 110° flexion with good strength. He is using his right limb for eating and washing his face, and using left limb for sanitary care.