Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases

Leechavengvongs, Somsak; Witoonchart, Kiat; Uerpairojkit, Chairoj; Thuvasethakul, Phairat

doi:10.1016/s0363-5023(03)00199-0

Cited by 331 publications

(222 citation statements)

References 20 publications

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“…Some other techniques were also employed in few cases, such as: phrenic to radial nerve transfer (6 cases); intercostals T3, T4 and T5 to musculocutaneous nerve transfer (3 cases) or to the branch of the long head of triceps (3 cases); contralateral C7 root to median nerve transfer (2 cases), and C2 nerve root to accessory nerve transfer (1 case). Significantly better outcomes were associated to the Oberlin's procedure (transfer of a motor fascicle from the ulnar nerve to the nerve of the biceps) 10 (Fig 3) and the Sansak's procedure (transfer of a motor branch from the radial nerve to the posterior division of the axilary nerve) 11 . The techniques of phrenic to musculocutaneous nerve and accessory to suprascapular nerve transfer did not reach statistical significance regarding good outcomes.…”

Section: Resultsmentioning

confidence: 99%

Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome

Flores¹

2011

Arq. Neuro-Psiquiatr.

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Objective:The study aims to demonstrate the techniques employed in surgery of the brachial plexus that are associated to evidence-based improvement of the functional outcome of these patients. Method: A retrospective study of one hundred cases of traumatic brachial plexus injuries. Comparison between the postoperative outcomes associated to some different surgical techniques was demonstrated. Results: The technique of proximal nerve roots grafting was associated to good results in about 70% of the cases. Significantly better outcomes were associated to the Oberlin's procedure and the Sansak's procedure, while the improvement of outcomes associated to phrenic to musculocutaneous nerve and the accessory to suprascapular nerve transfer did not reach statistical significance. Reinnervation of the hand was observed in less than 30% of the cases. Conclusion: Brachial plexus surgery renders satisfactory results for reinnervation of the proximal musculature of the upper limb, however the same good outcomes are not usually associated to the reinnervation of the hand. Key words: brachial plexus surgery, nerve grafting, nerve transfer, palsy.Cirurgia do plexo braquial: o papel da técnica cirúrgica para a obtenção de melhores resultados funcionais RESUMO Objetivo: Análise de resultados das técnicas que comprovadamente melhoraram o prognóstico funcional de pacientes com lesões traumáticas do plexo braquial. Método: Estudo retrospectivo de cem casos de lesões traumáticas do plexo braquial. Foi realizada comparação dos resultados pós-operatórios obtidos com as diferentes técnicas utilizadas. Resultados: A técnica de enxertia a partir de raízes proximais resultou em bons graus de reinervação em 70% dos casos. Bons resultados (p<0,05) também foram relacionados à técnica de Oberlin e de Sansak, enquanto que a transferência frênico-musculocutâneo e acessório-suprascapular não resultaram em melhora que atingisse significância estatística. Reinervação motora da mão foi observada em menos de 30% dos casos. Conclusão: A cirurgia de reinervação do plexo braquial em geral resulta em boa recuperação da função proximal do membro, porém esses mesmos bons resultados não são observados em termos de reinervação da mão. Palavras-chave: cirurgia de plexo braquial, enxertos nervosos, transferência de nervos, paralisia.

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Section: Resultsmentioning

confidence: 99%

Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome

Flores¹

2011

Arq. Neuro-Psiquiatr.

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“…Looking at Leechavengongs' series, none of his patients achieved M5 strength. 3,5 None of our multiple nerve transfer patients achieved M5 strength either. However, one of our isolated axillary nerve injury patients achieved M5 strength.…”

Section: Dojmentioning

confidence: 80%

“…1 Among these, transfer of a branch of the radial nerve to the axillary nerve has shown promising results for restoring deltoid strength and shoulder abduction. [2][3][4] The purpose of this study was to review our experience in restoring deltoid strength and shoulder abduction by neurotization of a branch of the radial nerve (Fig. 2) to the axillary nerve, as described by Leechavenvongs, 3,5 in patients with a brachial plexus or axillary nerve injury resulting from trauma or shoulder arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4] The purpose of this study was to review our experience in restoring deltoid strength and shoulder abduction by neurotization of a branch of the radial nerve (Fig. 2) to the axillary nerve, as described by Leechavenvongs, 3,5 in patients with a brachial plexus or axillary nerve injury resulting from trauma or shoulder arthroplasty. We hypothesized that transfer of a branch of the radial nerve to the anterior branch of the axillary nerve would significantly improve shoulder function after either traumatic or shoulder arthroplasty-related brachial plexus or axillary nerve injury.…”

Section: Introductionmentioning

confidence: 99%

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Restoration of Shoulder Abduction after Radial to Axillary Nerve Transfer following Trauma or Shoulder Arthroplasty

Nunley¹,

Leversedge²,

Wray³

et al. 2013

The Duke Orthopaedic Journal

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Purpose: A loss of active shoulder abduction due to axillary nerve dysfunction may be caused by brachial plexus or isolated axillary nerve injury and is often associated with a severe functional deficit. The purpose of this study was to evaluate retrospectively the restoration of deltoid strength and shoulder abduction after transfer of a branch of the radial nerve to the axillary nerve for patients who had sustained an axillary nerve injury. Materials and methods:We retrospectively reviewed all patients who underwent transfer of a branch of the radial nerve to the anterior branch of the axillary nerve at our institution, either alone or in combination with other nerve transfers, between 2004 and 2011. We identified, by chart review, 12 patients with an average follow-up of 16.7 months (6-36 months) who met inclusion criteria.Results: Active shoulder abduction significantly improved from an average of 9.6° (0-60°) to 84.5° (0-160°) (p < 0.005). Average initial deltoid strength significantly improved from 0.3 (0-2) on the M scale to an average postoperative deltoid strength of 2.8 (0-5) (p < 0.005). Five of 12 (41.7%) achieved at least M4 strength and eight of 12 (66.7%) achieved at least M3 strength. No statistically significant difference was seen when subgroup analysis was performed for isolated nerve transfer vs multiple nerve transfer, mechanism of injury with MVC vs shoulder arthroplasty, age, branch of radial nerve transferred, or time from injury to surgery. No significant change in triceps strength was observed with an average of 4.9 (4-5) strength preoperatively and 4.8 (4-5) postoperatively (p = 0.34). There were three patients who achieved no significant gain in shoulder abduction or deltoid strength for unknown reasons. Conclusion:Transfer of a branch of the radial nerve to the anterior branch of the axillary nerve is successful in improving deltoid strength and shoulder abduction in most patients. Our series, the largest North American series to our knowledge, has not shown outcomes as favorable as other series. Larger multicenter trials are needed.Type of study/Level of evidence: This is a retrospective case series representing a level IV study.

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“…In patients following nerve injury, neuropathic pain can contribute to significant disability and has been reported following peripheral nerve injury, particularly in patients with brachial plexus injuries [5,8,18,28,31,42]. Many outcome studies of nerve-injured patients present motor and sensory functional outcomes but do not report information regarding the absence or presence of pain [1,7,16,17,30,35,36,38,41,44]. In the surgical literature, many studies that report pain in nerve-injured patients generally use unidimensional measures (verbal ratings or visual analog scales of pain intensity) and do not include assessment of the psychosocial factors that may be associated with pain [5,8,28,32,34,40,42].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Pain Measurement Practices and Opinions of Peripheral Nerve Surgeons

Novak

Anastakis

Beaton

et al. 2009

Hand (New York, N,Y.)

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The purpose of this study was to evaluate the opinions and practices of peripheral nerve surgeons regarding assessment and treatment of pain in patients following nerve injury. Surgeons with expertise in upper extremity peripheral nerve injuries and members of an international peripheral nerve society were sent an introductory letter and electronic survey by email (n=133). Seventy members responded to the survey (49%) and 59 surgeons completed the survey (44%). For patients referred for motor or sensory dysfunction, 31 surgeons (52%) indicated that they always formally assess pain. In patients referred for pain, 44 surgeons (75%) quantitatively assess pain using a verbal scale (n=24) or verbal numeric scale (n=36). The most frequent factors considered very important in the development of chronic neuropathic pain were psychosocial factors (64%), mechanism of injury (59%), workers' compensation or litigation (54%), and iatrogenic injury (48%). In patients more than 6 months following injury, surgeons frequently see: cold sensitivity (54%), decreased motor function (42%), paraesthesia or numbness (41%), fear of returning to work (22%), neuropathic pain (20%), and emotional or psychological distress (17%). Only 52% of surgeons who responded to the survey always evaluate pain in patients referred for motor or sensory dysfunction. Pain assessment most frequently includes verbal patient response, and assessment of psychosocial factors is rarely included. Predominately, patient-related factors were considered important in the development of chronic neuropathic pain.

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Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases

Cited by 331 publications

References 20 publications

Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome

Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome

Restoration of Shoulder Abduction after Radial to Axillary Nerve Transfer following Trauma or Shoulder Arthroplasty

Evaluation of Pain Measurement Practices and Opinions of Peripheral Nerve Surgeons

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