Radial to Axillary Nerve Transfers: A Combined Case Series

Desai, Mihir J.; Daly, Charles A.; Seiler, John G.; Wray, Walter H.; Ruch, David S.; Leversedge, Fraser J.

doi:10.1016/j.jhsa.2016.08.022

Cited by 30 publications

(23 citation statements)

References 18 publications

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“…13 One suggested surgical solution for the treatment of axillary nerve injuries is a partial radial nerve to axillary nerve transfer. 20 However, this procedure has variable results and is not widely accepted currently. If human MEPs persist and retain their structures even after the previously postulated 6-month therapeutic window for operative intervention, then a partial radial nerve to axillary nerve transfer may indeed be indicated.…”

Section: Implications For Timing Of Reparative Surgery Following Perimentioning

confidence: 99%

Human motor endplate remodeling after traumatic nerve injury

Gupta

Chan

Uong

et al. 2020

Journal of Neurosurgery

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OBJECTIVECurrent management of traumatic peripheral nerve injuries is variable with operative decisions based on assumptions that irreversible degeneration of the human motor endplate (MEP) follows prolonged denervation and precludes reinnervation. However, the mechanism and time course of MEP changes after human peripheral nerve injury have not been investigated. Consequently, there are no objective measures by which to determine the probability of spontaneous recovery and the optimal timing of surgical intervention. To improve guidance for such decisions, the aim of this study was to characterize morphological changes at the human MEP following traumatic nerve injury.METHODSA prospective cohort (here analyzed retrospectively) of 18 patients with traumatic brachial plexus and axillary nerve injuries underwent biopsy of denervated muscles from the upper extremity from 3 days to 6 years after injury. Muscle specimens were processed for H & E staining and immunohistochemistry, with visualization via confocal and two-photon excitation microscopy.RESULTSImmunohistochemical analysis demonstrated varying degrees of fragmentation and acetylcholine receptor dispersion in denervated muscles. Comparison of denervated muscles at different times postinjury revealed progressively increasing degeneration. Linear regression analysis of 3D reconstructions revealed significant linear decreases in MEP volume (R = −0.92, R2 = 0.85, p = 0.001) and surface area (R = −0.75, R2 = 0.56, p = 0.032) as deltoid muscle denervation time increased. Surprisingly, innervated and structurally intact MEPs persisted in denervated muscle specimens from multiple patients 6 or more months after nerve injury, including 2 patients who had presented > 3 years after nerve injury.CONCLUSIONSThis study details novel and critically important data about the morphology and temporal sequence of events involved in human MEP degradation after traumatic nerve injuries. Surprisingly, human MEPs not only persisted, but also retained their structures beyond the assumed 6-month window for therapeutic surgical intervention based on previous clinical studies. Preoperative muscle biopsy in patients being considered for nerve transfer may be a useful prognostic tool to determine MEP viability in denervated muscle, with surviving MEPs also being targets for adjuvant therapy.

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Section: Implications For Timing Of Reparative Surgery Following Perimentioning

confidence: 99%

Human motor endplate remodeling after traumatic nerve injury

Gupta

Chan

Uong

et al. 2020

Journal of Neurosurgery

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“…Different authors advocate the use of the medial or long heads of the triceps muscle, but it may be recommended not to use the branch to the medial head since it is important for powerful elbow extension. 50,51 …”

Section: Treatment Of Nerve Injuriesmentioning

confidence: 99%

Nerve injuries of the upper extremity and hand

Dahlin

Wiberg

2017

EFORT Open Reviews

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A nerve injury has a profound impact on the patient’s daily life due to the impaired sensory and motor function, impaired dexterity, sensitivity to cold as well as eventual pain problems.To perform an appropriate treatment of nerve injuries, a correct diagnosis must be made, where the injury is properly classified, leading to an optimal surgical approach and technique, where timing of surgery is also important for the outcome.Knowledge about the nerve regeneration process, where delicate processes occur in neurons, non-neuronal cells (i.e. Schwann cells) and other cells in the peripheral as well as the central nervous systems, is crucial for the treating surgeon.The surgical decision to perform nerve repair and/or reconstruction depends on the type of injury, the condition of the wound as well as the vascularity of the wound.To reconnect injured nerve ends, various techniques can be used, which include both epineurial and fascicular nerve repair, and if a nerve defect is caused by the injury, a nerve reconstruction procedure has to be performed, including bridging the defect using nerve-grafts or nerve transfer techniques.The patients must be evaluated properly and regularly after the surgical procedure and appropriate rehabilitation programmes are useful to improve the final outcome.Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160071. Originally published online at www.efortopenreviews.org

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“…1, 5,24 Multiple studies have demonstrated that a triceps nerve to axillary nerve transfer leads to increased deltoid strength in both pediatric and adult populations with axillary nerve injury. 8,14,27,29 This surgery may increase shoulder endurance postoperatively. 3 Additionally, these nerve transfers do not cause donor-site morbidity as would be demonstrated by decreased triceps strength.…”

Section: Discussionmentioning

confidence: 99%

Isolated Axillary Nerve Injury in an Elite High School American Football Player: A Case Report

2019

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An elite high school American football athlete sustained a traumatic, isolated, axillary nerve injury. Axillary nerve injuries are uncommon, but serious injuries in American football. With the advent of nerve transfers and grafts, these injuries, if diagnosed in a timely manner, are treatable. This case report discusses the multidisciplinary approach necessary for the diagnosis and treatment of an elite high school American football player who presented with marked deltoid atrophy. The athlete’s injury was diagnosed via electrodiagnostic testing and he underwent a medial triceps nerve to axillary nerve transfer. After appropriate postsurgical therapy, the athlete was able to return to American football the subsequent season and continue performing at an elite level. This case report reviews the evaluation and modern treatment for axillary nerve injuries in the athlete, including nerve transfers, nerve grafts, and return to play.

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Radial to Axillary Nerve Transfers: A Combined Case Series

Cited by 30 publications

References 18 publications

Human motor endplate remodeling after traumatic nerve injury

Human motor endplate remodeling after traumatic nerve injury

Nerve injuries of the upper extremity and hand

Isolated Axillary Nerve Injury in an Elite High School American Football Player: A Case Report

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