Dorsal Scapular Nerve Transfer to Suprascapular Nerve

Abstract

Background: Obstetrical brachial plexus injury involving the suprascapular nerve is conventionally treated using an accessory nerve transfer or grafting. In circumstances where the accessory nerve is unsuitable, transfer of nerves with redundant function may be an alternate method of restoring function. Methods: This case describes the surgical technique of restoring shoulder function by reinnervating the musculature of the suprascapular nerve with a dorsal scapular nerve transfer in a patient with an obstetrical brachial plexus injury. Results: At 15 months post-operatively, the patient shoulder movement improved from zero muscle contraction to full range of motion against gravity measured by the active movement scale. His composite mallet score was 23 out of 25, with perfect scores in abduction and external rotation. Secondary surgery was not required. Conclusions: This case demonstrates a novel alternative to suprascapular nerve reinnervation in circumstances where the accessory nerve is unavailable, damaged, or otherwise suboptimal. Successful results were achieved, thus warranting consideration in clinical practice as well as further exploration and study.

Topographic and morphometric anatomy of the proximal part of the dorsal scapular nerve

“…From a clinical point of view, studies are showing that the transfer of the DSN to the suprascapular nerve results in a positive result (Augustine et al, 2017; Goubier & Teboul, 2015). Additionally, in the study by Jack et al (2020), the first branch to emerge from the anterior ramus of the C5 spinal nerve is usually the DSN and therefore, it was stated that knowledge about the proximal anatomy of the nerve may help in pathology localization and monitoring of clinical and neurophysiological recovery.…”

“…In the study of Augustine et al (2017), after the DSN was separated from the middle scalene muscle and its length was adjusted, it was transferred to the suprascapular nerve. In this operation, for the transfer phase and in surgeries related to the scalene muscles, in order to prevent any iatrogenic nerve damage that may occur, the length of the nerve in the muscle/muscles may be important.…”