Restoration of shoulder function with nerve transfers in traumatic brachial plexus palsy patients

Abstract

Shoulder stabilization is of utmost importance in upper extremity reanimation following paralysis from devastating injuries. Although secondary procedures such as tendon and muscle transfers have been used, they never achieve a functional recovery comparable to that following successful reinnervation of the supraspinatus, deltoid, teres minor, and infraspinatus muscles. Early restoration of suprascapular and axillary nerve function through timely brachial plexus reconstruction offers a good opportunity to restore shoulder-joint stability, adequate shoulder abduction, and external rotation function. Overall, in our series, 79% of patients achieved good and excellent shoulder abduction (muscle grade, +3 or more), and 55% of patients achieved good or excellent shoulder external rotation after reinnervation of the suprascapular nerve. The best results were seen when direct neurotization of the suprascapular nerve from the distal spinal accessory nerve or neurotization by the C5 root was carried out. Concomitant neurotization of the axillary nerve yields improved outcomes in shoulder abduction and external rotation function.

The Effect of Humerus Diaphyseal Shortening on Brachial Plexus Tension: A Cadaver Study

“…18 But in the more frequent lesions caused by traction on the arm, nerve lesions show extensive scarring, and a large resection of the already-retracted nerve ends has to be performed until acceptable nerve stumps are available. This procedure greatly increases the necessary length of the nerve grafts, often over 7 cm, 19 hence the gain in nerve length observed by humeral shortening of 6 cm is insufficient in most brachial plexus lesions, except perhaps in selected gunshot wounds or lacerations.…”

End-to-side neurorrhaphy in brachial plexus reconstruction

“…In axillary nerve reconstruction, good results have been obtained using the 1) spinal accessory nerve (60%), 27 2) phrenic nerve (66%), 27 3) intercostal nerves (33%-67%), 14,19,33 4) thoracodorsal nerves (36%-93%), 23,28 5) C-5 and/or C-6 root via nerve grafts (67%), 34 or 6) the contralateral C-7 root (52%) as the donor of motor nerve fibers. 31 Recently, successful neurotization using a branch of the radial nerve for the triceps muscle as donor was performed with very good results.…”

Dorsal Approach in Transfer of the Distal Spinal Accessory Nerve Into the Suprascapular Nerve: Histomorphometric Analysis and Clinical Results in 14 Cases of Upper Brachial Plexus Injuries

“…Terzis et al 12 reported that the SSN is vulnerable at 3 points: (1) as it leaves the upper trunk, (2) at the suprascapular notch, and (3) at the spinoglenoid notch where it bends around the spine of the scapula. The nerve may be injured directly by bone fragments when the fracture is located at the spinoglenoid notch.…”