Subscapular Release Operation for Brachial Plexus Injury at Clinic of Plastic & Hand Surgery of University Hospital Rechts der Isar Munich

The clinic for plastic and hand surgery at the TUM University Hospital Rechts der Isar in Munich is a premier European center for the reconstruction of complex peripheral nerve disorders. Among our highly specialized surgical offerings is the subscapular release procedure, meticulously tailored for patients with brachial plexus injuries. This procedure is primarily designed to address the severe internal rotation contractures of the shoulder that frequently develop following obstetric brachial plexus palsy or traumatic nerve lesions. By leveraging the microsurgical expertise and comprehensive interdisciplinary approach characteristic of our academic institution, this operation aims to restore essential shoulder mechanics, prevent long-term joint deformation, and significantly enhance the functional range of motion in the affected arm. The foundation of a successful subscapular release at our clinic relies on highly precise, individualized pre-operative planning. Before entering the operating theater, patients undergo an exhaustive biomechanical and structural evaluation by our specialized hand and peripheral nerve surgeons. This includes advanced dynamic assessments and high-resolution magnetic resonance imaging of the shoulder joint to evaluate the exact degree of glenohumeral dysplasia and map the specific tension patterns of the rotator cuff muscles. By defining the exact state of the joint capsule and identifying the muscular imbalances causing the internal rotation contracture, our surgical team determines precisely how much of the subscapularis muscle must be released to optimize external rotation without compromising the fundamental stability of the shoulder joint. During the operation, our surgical team employs advanced, minimally traumatic techniques to access the anterior shoulder compartment, prioritizing the absolute protection of the surrounding neurovascular structures. The core of the procedure involves the careful lengthening or fractional release of the contracted subscapularis muscle-tendon unit and, when clinically indicated, an anterior capsulotomy. In many complex brachial plexus cases treated at our Munich center, this passive release is seamlessly combined with active secondary muscle transfers, such as the rerouting of the latissimus dorsi or teres major muscles. This concurrent tendon transfer actively rebalances the shoulder biomechanics, providing the newly liberated joint with the active power necessary to maintain external rotation and execute overhead abduction. The structural gains achieved in the operating room are immediately supported by our dedicated neuro-rehabilitation protocol, an essential component of the Rechts der Isar clinical pathway. Upon completion of the surgery, the patient’s arm is meticulously secured in a custom-molded thermoplastic splint or cast, holding the shoulder in a specific degree of external rotation and abduction to allow the released tissues to heal in their newly elongated state. Following this crucial initial period of immobilization, patients transition into a highly structured, intensive physiotherapy program supervised by our specialized occupational and physical therapists.