C5/C6 brachial plexus palsy reconstruction using nerve surgery: long-term functional outcomes

Pages, Laure; Hanneur, Malo Le; Belkheyar, Zoubir

doi:10.1016/j.otsr.2020.03.033

Cited by 6 publications

(3 citation statements)

References 22 publications

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“…Moreover, in our experience, shoulder external rotation was clinically noticeable 6 months earlier than after a spinal accessory nerve Volume 149, Number 3 • C7 Fascicle Transfer to Suprascapular Nerve transfer to the suprascapular nerve, and its recovery was superior in term of range of motion and strength, as we showed in a previous published series. 25 The main limits of the current study include its retrospective nature and the small size of the series. Moreover, shoulder abduction recovery cannot specifically be attributed to suprascapular nerve reinnervation, as a transfer to the axillary nerve was also performed.…”

Section: Discussionmentioning

confidence: 95%

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Transfer of a C7 Fascicle for the Pectoralis Major to the Suprascapular Nerve: A 3-Year Follow-Up Patient Series

Belkheyar

2022

Plastic &Amp; Reconstructive Surgery

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Background: In patients with C5-C6 brachial plexus injury, spinal accessory nerve transfer to the suprascapular nerve is usually performed for the restoration of shoulder abduction. In order to minimize donor deficits, we transferred one fascicle of the ipsilateral C7 root, dedicated to the pectoralis major muscle, to the suprascapular nerve. Methods: Ten patients with a mean age of 33 years (range, 19 to 51 years) were operated on at a mean delay of 4 months after their trauma (range, 2 to 7 months). Patients had C5-C6 brachial plexus palsy with avulsed roots on spinal magnetic resonance imaging scan. In addition to the partial C7 transfer, patients sustained nerve transfers to the posterior branch of the axillary nerve and to the motor branches of the musculocutaneous nerve for the biceps and brachialis muscles. Results: At a mean follow-up of 36 months (range, 29 to 42 months), mean shoulder abduction and external rotation ranges of motion were, respectively, 99 degrees (range, 60 to 120 degrees; p = 0.001) and 58 degrees (range, 0 to 80 degrees; p = 0.001). In nine patients, shoulder abduction strength was graded M4, according the British Medical Research Council grading scale, against 1.6 kg (range, 1 to 2 kg), and was graded M3 in one patient. External rotation strength was graded M4 in nine patients and M3 in one patient. Residual strength of the pectoralis major muscle was graded M4+ in every patient. Conclusions: C7 partial transfer to the suprascapular nerve showed satisfactory results at long-term follow-up for active shoulder abduction and external rotation recovery in C5-C6 brachial plexus palsies. This technique replaced spinal accessory nerve transfer in the authors’ practice. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Section: Discussionmentioning

confidence: 95%

“…Moreover, in our experience, shoulder external rotation was clinically noticeable 6 months earlier than after a spinal accessory nerve transfer to the suprascapular nerve, and its recovery was superior in term of range of motion and strength, as we showed in a previous published series. 25…”

Section: Discussionmentioning

confidence: 99%

Transfer of a C7 Fascicle for the Pectoralis Major to the Suprascapular Nerve: A 3-Year Follow-Up Patient Series

Belkheyar

2022

Plastic &Amp; Reconstructive Surgery

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“…A retrospective study including 325 patients with adult traumatic brachial plexus injury found that nerve injury with vascular injury leads to worse functional outcomes after reconstructive surgery than without vascular injury [ 53 ]. Pages et al [ 54 ] showed that brachial plexus injury could be functionally or structurally restored by nerve reconstruction, with early nerve surgery yielding satisfactory functional outcomes. Patients younger than 30 years old and those operated upon earlier than 6 months from the accident having better functional recovery [ 55 ] through intercostal nerve transfers [ 56 ].…”

Section: Achievements and Progress In Clinical Diagnosis And Neurores...mentioning

confidence: 99%

The 2020 Yearbook of Neurorestoratology

Huang¹,

Chen²,

Chopp³

et al. 2021

Journal of Neurorestoratology

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COVID-19 has been an emerging and rapidly evolving risk to people of the world in 2020. Facing this dangerous situation, many colleagues in Neurorestoratology did their best to avoid infection if themselves and their patients, and continued their work in the research areas described in the 2020 Yearbook of Neurorestoratology. Neurorestorative achievements and progress during 2020 includes recent findings on the pathogenesis of neurological diseases, neurorestorative mechanisms and clinical therapeutic achievements. Therapeutic progress during this year included advances in cell therapies, neurostimulation/neuromodulation, brain-computer interface (BCI), and pharmaceutical neurorestorative therapies, which improved neurological functions and quality of life for patients. Four clinical guidelines or standards of Neurorestoratology were published in 2020. Milestone examples include: 1) a multicenter randomized, double-blind, placebo-controlled study of olfactory ensheathing cell treatment of chronic stroke showed functional improvements; 2) patients after transhumeral amputation experienced increased sensory acuity and had improved effectiveness in work and other activities of daily life using a prosthesis; 3) a patient with amyotrophic lateral sclerosis used a steady-state visual evoked potential (SSVEP)-based BCI to achieve accurate and speedy computer input; 4) a patient with complete chronic spinal cord injury recovered both motor function and touch sensation with a BCI and restored ability to detect objects by touch and several sensorimotor functions. We hope these achievements motivate and encourage other scientists and physicians to increase neurorestorative research and its therapeutic applications.

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Ballistic peripheral nerve injuries: basic concepts, controversies, and proposal for a management strategy

Mathieu

Goncalves

Murison

et al. 2022

Eur J Trauma Emerg Surg

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C5/C6 brachial plexus palsy reconstruction using nerve surgery: long-term functional outcomes

Cited by 6 publications

References 22 publications

Transfer of a C7 Fascicle for the Pectoralis Major to the Suprascapular Nerve: A 3-Year Follow-Up Patient Series

Transfer of a C7 Fascicle for the Pectoralis Major to the Suprascapular Nerve: A 3-Year Follow-Up Patient Series

The 2020 Yearbook of Neurorestoratology

Ballistic peripheral nerve injuries: basic concepts, controversies, and proposal for a management strategy

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