Outcome of Nerve Transfers by Posterior Approach for Shoulder Restoration in Upper Brachial Plexus Injuries
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Abstract
Introduction: Extra-plexus nerve transfers are the mainstay of treatment for return of function in upper brachial plexus injuries. For shoulder restoration, spinal accessory to suprascapular nerve transfer and Somsak transfer is the choice of nerve transfer. The posterior approach for spinal accessory to suprascapular nerve and nerve to the medial head of triceps to axillary nerve transfer has gained momentum in recent times. This study reports the outcome of the posterior approach of nerve transfers for shoulder restoration.
Methods: Spinal accessory nerve to suprascapular transfer and medical head of triceps to axillary nerve transfer were performed in patients with upper brachial plexus injuries presenting within a year of injury. Postoperative range of motion of shoulder abduction along with external rotation and timing of return of function were recorded.
Results: 11 patients underwent nerve transfers. The mean duration since injury was 7.72 months and mean follow-up period was 11 months ranging from 8 to 18 months. The timing of the return of shoulder function was 26.09 weeks (range from 22 to 28 weeks). Average shoulder abduction and shoulder abduction were 74.3 and 66.6 degrees respectively.
Conclusion: Spinal accessory to suprascapular nerve transfer through posterior approach is an attractive alternative to anterior approach with early return of function. Nerve to medial head of triceps to axillary nerve transfer proximal to teres minor branch provides better external rotation.
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