Nerve Transfers to the Musculocutaneous and Suprascapular Nerve for Restoration of Elbow and Shoulder Function in Brachial Plexus Avulsion: An Early Experience

Abstract

Loss of shoulder and elbow function is typical of upper brachial plexus avulsion 3,13) . Motor root avulsion of the C5 and C6 roots results in Erb palsy, with loss of supply to muscles innervated by the suprascapular nerve, axillary nerve, and musculocutaneous nerve 3) . In the case of root avulsion,The diagnosis of brachial plexus avulsion is often delayed by concomitant trauma to the arm and shoulder. Therefore, nerve transfer surgery to restore elbow and shoulder function is rarely reported. We present our initial experience of double fascicular nerve transfer for upper brachial plexus avulsion. A 26-year-old male patient presented with a 5-month history of unresolving pain and paralysis involving his left shoulder and elbow following a motorcycle accident. Avulsion of the C5 and C6 ventral roots and C6 dorsal root was confirmed by a myelographic computed tomography scan. After lesioning of the dorsal root entry zone due to painful avulsion, double fascicles (flexor carpi radialis and flexor carpi ulnaris) of the median and ulnar nerve) were transferred to the biceps brachii and brachialis branches of the musculocutaneous nerve to restore elbow flexion. Two weeks after the first transfer surgery, the distal accessory nerve was transferred to the suprascapular nerve to ensure shoulder function. Six months after the nerve transfers, elbow flexion recovered to Medical Research Council grade 3, but shoulder function did not show any improvement. An additional nerve transfer (triceps branch of the radial nerve to the axillary nerve) was planned for shoulder function. It is necessary to refine the microsurgical suture technique. For shoulder function, it is recommended to perform radial nerve transfer at the time of the first surgery.