Long-Term Results of Spinal Accessory Nerve Transfer to the Suprascapular Nerve in Upper-Type Paralysis of Brachial Plexus Injury

Abstract

In the management of upper type of brachial plexus injury, reconstruction to restore shoulder function is accomplished by multiple nerve transfers. We used the accessory nerve to neurotize the suprascapular nerve in 12 patients (11 men, 1 woman) from 1989 to 2003. The average age at the time of operation was 28.1 years (range 16 to 53). The mean preoperative time was 3.6 months. The type of paralysis was C5-C6 type in four cases, C5-C7 type in five cases, and C5-C8 type in three cases. The average time of follow-up was 28.5 months. All the patients showed reinnervation of the supraspinatus and infraspinatus muscles that was confirmed by electromyogram. At the time of final followup, the average shoulder flexion was 70.4 degrees and abduction was 77.1 degrees. However, average shoulder external rotation was only 16.7 degrees. We compared the shoulder flexion and abduction in patients with or without paralysis of the serratus anterior muscle and found significantly better functional outcome in the latter group of patients. We, therefore, conclude that repair of long thoracic nerve is mandatory for achieving optimum shoulder function.

Nerve Transfer to Serratus Anterior Muscle Using the Thoracodorsal Nerve for Winged Scapula in C5 and C6 Brachial Plexus Root Avulsions

“…However, there are important concerns about sling failure and recurrence of winging. 11 We support the concept of local nerve transfers over the muscle transfers because muscle biomechanics is not altered. 16 Direct nerve-to-nerve transfers can provide a closer nerve source to the target muscle and thereby enhance the quality and rate of recovery.…”

“…We believed that there were muscles other than serratus anterior, such as the pectoralis major and minor, participating to a lesser extent in shoulder protraction. 10 Recently, Suzuki et al 11 reported long-term results of spinal accessory nerve transfer to suprascapular nerve in upper-type paralysis of brachial plexus injury in 12 cases. The result of their comparison of shoulder flexion and abduction between patients with or without paralysis of the serratus anterior muscle revealed considerable and better functional outcome among patients without concomitant serratus anterior muscle paralysis.…”

Scapular Winging

“…Both of these can lead to painful winging wherescapulothoracicfusionhasbeenshowntobeasuccessfulfirst line surgery. Microneurosurgical nerve transfers are also gaining prominence in the management of scapula winging in association with brachial plexus injury [63][64][65]. Painful winging from diffuse traumatic damage to the scapula stabilizing muscles also responds well to scapulothoracic fusion.…”

Contralateral Spinal Accessory Nerve Transfer: A New Technique in Panavulsive Brachial Plexus Palsy

“…To date, there are numerous surgical procedures for brachial plexus reconstruction and is one of the most difficult problems among the traumatic injuries of nerves [2]. Many techniques have described the use of different nerves as donor nerves for transfer to the suprascapular nerve with the aim of returning shoulder and elbow function, with varying results [1][2][3][4][5]. This report aims to present and describe a new, alternative technique to repair brachial plexus avulsion and stabilize the shoulder when there are not enough donor nerves.…”