Latissimus Dorsi Transfer With Interposed Autograft for Axillary Nerve Palsy After Reverse Shoulder Arthroplasty: A Case Report

Persistent axillary nerve palsy after reverse shoulder arthroplasty (RSA) results in profound deltoid dysfunction and loss of active shoulder elevation. Traditional reconstructive options such as nerve repair or transfer may not be feasible in chronic cases. Latissimus dorsi tendon transfer augmented with an interposed graft has been described to restore shoulder abduction in deltoid-deficient shoulders, but its application after RSA is not well documented. We present the case of a 73-year-old female patient who developed chronic axillary nerve palsy following RSA performed for complex proximal humerus fracture. Despite exhaustive conservative and rehabilitative efforts over 18 months, active elevation remained severely limited, and electromyography confirmed irreversible nerve injury. Given the deltoid-dependent biomechanics of RSA, functional reconstruction was pursued. The patient underwent latissimus dorsi tendon transfer augmented with a semitendinosus autograft routed beneath the acromion and fixed to the deltoid tuberosity using suture anchors. This aimed to recreate a deltoid-like lever arm to restore active elevation. At 12 months postoperative follow-up, the patient demonstrated improved active shoulder elevation (up to 80°), enhanced stability, and increased functional independence in activities of daily living, with no significant complications. Latissimus dorsi transfer with interposed autograft may serve as a viable reconstructive strategy to improve shoulder elevation and function in selected patients with chronic axillary nerve palsy after RSA. Further studies are needed to better define indications and long-term outcomes.