Dual Nerve Transfers for Restoration of Shoulder Function After Brachial Plexus Avulsion Injury

Abstract

The purpose of this study was to investigate the effectiveness of shoulder function restoration by dual nerve transfers, spinal accessory nerve to the suprascapular nerve and 2 intercostal nerves to the anterior branch of the axillary nerve, in patients with shoulder paralysis that resulted from brachial plexus avulsion injury. It was a retrospective analysis to assess the impact of a variety of factors on reanimation of shoulder functions with dual nerve transfers. A total of 19 patients were included in this study. Most of these patients sustained avulsions of C5, C6, and C7 nerve roots (16 patients). Three of them had avulsions of C5 and C6 roots only. Through a posterior approach, direct coaptation of the intercostal nerves and the anterior branch of the axillary nerve was performed, along with accessory nerve transfer to the suprascapular nerve. Satisfactory shoulder function recovery (93.83° of shoulder abduction and 54.00° of external rotation on average) was achieved after a 62-month follow-up. This dual nerve transfer procedure provided us with a reliable and effective method for shoulder function reconstruction after brachial plexus root avulsion, especially C5/C6/C7 avulsion. The level of evidence is therapeutic IV.

The Outcome of Single Versus Double Nerve Transfers in Shoulder Reconstruction of Upper and Extended Upper-Type Brachial Plexus Injuries

“…In studies that investigated DNT procedures, the mean recovery of ≥M4 shoulder abduction ranged from 30% to 88.9%, 10 , 13 , 14 , 15 , 18 and the mean ROM ranged from 92º to 115º. 11 , 12 , 13 , 14 , 15 , 16 , 17 The mean recovery of ≥M4 external rotation ranged from 20% to 60%, with a mean ROM ranging from 54º to 136º. 11 , 12 , 13 , 14 , 15 , 16 , 17 In this case series, the results of the DNT for shoulder abduction were similar to published literature, reaching a mean of 99º with 69% of patients experiencing recovery ≥M4 and a mean of 69º of external rotation with 52% of patients having ≥M4 recovery.…”

“…Chu et al 12 reported in their DNT series that patients with longer than 24 months of follow-up and a surgical delay of <3 months had a significantly greater ROM for shoulder abduction but not for external rotation. They also reported a significantly greater ROM for shoulder abduction and external rotation for patients in the ≤30-year-old age group.…”

“…Leechavangvongs et al 10 , 11 reported using a triceps branch of the radial nerve to the axillary nerve via a posterior approach as a second nerve transfer to the shoulder after the spinal accessory nerve to the suprascapular nerve. Several authors have reported increased shoulder function after double nerve transfer (DNT) with the intercostal nerve 12 and median or ulnar nerve 13 as nerve donors and the axillary nerve as the target nerve. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 Cardenas et al 19 in their study in 2008 reported that the more nerves transferred, the higher the abduction range in restoring shoulder function.…”

“…Several authors have reported increased shoulder function after double nerve transfer (DNT) with the intercostal nerve 12 and median or ulnar nerve 13 as nerve donors and the axillary nerve as the target nerve. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 Cardenas et al 19 in their study in 2008 reported that the more nerves transferred, the higher the abduction range in restoring shoulder function. Similar studies comparing SNT with DNT reported a greater shoulder range of motion (ROM) or a higher recovery rate of ≥M4 for shoulder function with DNT.…”

Restoration of shoulder motion using single- versus dual-nerve repair in obstetrical brachial plexus injury

“…15,16,19 Double-and triple-nerve transfers also have been widely used with various combinations of recipients and donors with or without nerve grafts. [2][3][4]6 In this study, we investigated the results of shoulder abduction and ER in patients after single-nerve repair of the upper trunk versus those in patients after dual-nerve repair of the upper trunk and the suprascapular nerve.…”