Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part I: an anatomic feasibility study

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

doi:10.1016/s0363-5023(03)00200-4

Cited by 166 publications

(94 citation statements)

References 18 publications

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“…Witoonchart et al [13] described the concept of using the radial nerve branch to the long head of the triceps brachii for reinnervation of the anterior branch of the axillary nerve in upper brachial plexus injuries. In selected cases, the ulnar collateral branch of the radial nerve to the ulnar nerve or motor branch ramifying from the ulnar nerve could be used for reinnervation of a denervated muscle closely situated.…”

Section: Discussionmentioning

confidence: 99%

A Cadaveric Study of Ulnar Nerve Innervation of the Medial Head of Triceps Brachii

Bekler

Wolfe

Rosenwasser

2009

Clinical Orthopaedics &Amp; Related Research

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The presence of a separately innervated muscle unit of the triceps may have possible surgical importance and can be used for motor reconstructions. The ulnar nerve is closely situated to the triceps muscle and rarely examined above the elbow. The aim of this cadaveric study was to explore a possible contribution of the ulnar nerve to motor innervation of the medial head of the triceps. We dissected 18 limbs from axillae to midforearm. The path of the ulnar nerve was followed, and examination was conducted of attachments to the triceps. Gross photographs were taken and samples histologically stained. Seventeen limbs had ulnar nerve branches proximal to the epicondyles that inserted on the medial head. Eleven of these branches were from the ulnar nerve trunk. The other six were nerve branches from the ulnar collateral branch of the radial nerve. The ulnar nerve and the ulnar collateral branch of the radial nerve are previously unrecognized sources of innervation of the medial head of the triceps brachii. These motor branches must be carefully preserved during the medial surgical approach above the elbow. The ulnar innervated part of the medial head of the triceps muscle may be used like an independent motor unit.

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Section: Discussionmentioning

confidence: 99%

A Cadaveric Study of Ulnar Nerve Innervation of the Medial Head of Triceps Brachii

Bekler

Wolfe

Rosenwasser

2009

Clinical Orthopaedics &Amp; Related Research

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“…2 They found the diameter, number of axons, and the anatomic proximity of the nerve to the long head of the triceps to be acceptable for potential transfer to the anterior branch of the axillary nerve. This was followed up with a retrospective review of 15 patients with complete C5-6 avulsion injuries.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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“…While nerve grafting has been recommended for repair of axillary nerve lesions, 10,18 the triceps motor branch transfer to the axillary nerve for reinnervation of the deltoid muscle, as initially described by Leechavengvongs et al 13,22 for treatment of lesions of the upper trunk, has been increasingly used in lieu of nerve grafting by our group and others 3,7,12,19 for treatment of isolated axillary nerve lesions. The triceps motor branch transfer has the advantage of having the donor nerve much closer to the deltoid, resulting in a shorter distance required for nerve growth to the motor end plate.…”

mentioning

confidence: 98%

Triceps motor branch transfer for isolated traumatic pediatric axillary nerve injuries

Chim¹,

Kircher²,

Spinner

et al. 2015

PED

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OBJECT Transfer of the triceps motor branch has been used for treatment of isolated axillary nerve palsy in the adult population. However, there are no published data on the effectiveness of this procedure in the pediatric population with traumatic injuries. The authors reviewed demographics and outcomes in their series of pediatric patients who underwent this procedure. METHODS Six patients ranging in age from 10 to 17 years underwent triceps motor branch transfer for the treatment of isolated axillary nerve injuries between 4 and 8 months after the inciting injury. Deltoid muscle strength was evaluated using the modified British Medical Research Council (MRC) grading system. Shoulder abduction at last follow-up was measured. RESULTS The mean duration of follow-up was 38 months. The average postoperative MRC grading of deltoid muscle strength was 3.6 ± 1.3. The median MRC grade was 4. One patient who did not achieve an MRC grade of 3 suffered multiple injuries from high-velocity trauma. Unlike in the adult population, age, body mass index of the patient, and delay from injury to surgery were not significant factors affecting the outcome of the procedure. CONCLUSIONS In the pediatric population with traumatic injuries, isolated axillary nerve injury treated with triceps motor branch transfer can result in good outcomes.

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Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part I: an anatomic feasibility study

Cited by 166 publications

References 18 publications

A Cadaveric Study of Ulnar Nerve Innervation of the Medial Head of Triceps Brachii

A Cadaveric Study of Ulnar Nerve Innervation of the Medial Head of Triceps Brachii

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

Triceps motor branch transfer for isolated traumatic pediatric axillary nerve injuries

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