Long-term outcome of accessory nerve to suprascapular nerve transfer in obstetric brachial plexus lesion: functional, morphological, and electrophysiological results

2015 ◽  
Vol 31 (9) ◽  
pp. 1541-1546 ◽  
Author(s):  
Matthias Gmeiner ◽  
Raffi Topakian ◽  
Manuel Göschl ◽  
Sarah Wurm ◽  
Anita Holzinger ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Accessory Nerve ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Obstetric Brachial Plexus ◽  
Plexus Lesion ◽  
Obstetric Brachial Plexus Lesion

Accessory Nerve to Suprascapular Nerve Transfer to Restore Shoulder Exorotation in Otherwise Spontaneously Recovered Obstetric Brachial Plexus Lesions

Neurosurgery ◽  
2006 ◽  
Vol 59 (4) ◽  
pp. 858-869 ◽  
Author(s):  
Willem J.R. van Ouwerkerk ◽  
Bernard M.J. Uitdehaag ◽  
Rob L.M. Strijers ◽  
Frans Nollet ◽  
Kurt Holl ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Brachial Plexus ◽  
Spontaneous Recovery ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Resonance Imaging ◽  
Obstetric Brachial Plexus ◽  
Plexus Lesion

Abstract OBJECTIVE: A systematic follow-up of infants with an obstetric brachial plexus lesion of C5 and C6 or the superior trunk showing satisfactory spontaneous recovery of shoulder and arm function except for voluntary shoulder exorotation, who underwent an accessory to suprascapular nerve transfer to improve active shoulder exorotation, to evaluate for functional recovery, and to understand why other superior trunk functions spontaneously recover in contrast with exorotation. METHODS: In 54 children, an accessory to suprascapular nerve transfer was performed as a separate procedure at a mean age of 21.7 months. Follow-up examinations were conducted before and at 4, 8, 12, 24, and 36 months after operation and included scoring of shoulder exorotation and abduction. Intraoperative reactivity of spinatus muscles and additional needle electromyographic responses were registered after electrostimulation of suprascapular nerves. Histological examination of suprascapular nerves was performed. Trophy of spinatus muscles was followed by magnetic resonance imaging scanning. The influence of perinatal variables and results of ancillary investigations on outcome were evaluated. RESULTS: Exorotation improved from 70 degrees to functional levels exceeding 0 degrees, except in two patients. Abduction improved in 27 patients, with results of 90 degrees or more in 49 patients. Electromyography at 4 months did not show signs of denervation in 39 out of 40 patients. Intraoperative electrostimulation of suprascapular nerves elicited spinatus muscle reaction in 44 out of 48 patients. Histology of suprascapular nerves was normal. Preoperative magnetic resonance imaging scans showed only minor wasting of spinatus muscles in contrast with major wasting after successful operations. CONCLUSION: An accessory to suprascapular nerve transfer is effective to restore active exorotation when performed as the primary or a separate secondary procedure in children older than 10 months of age. Contradictory spontaneous recovery of other superior trunk functions and integrity of suprascapular nerves, as well as absence of spinatus muscle wasting direct to central nervous changes are possible main causes for the lack of exorotation.

Long-Term Outcome of Phrenic Nerve Transfer in Brachial Plexus Avulsion Injuries

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Tarek Abdalla El-Gammal ◽  
Amr El-Sayed ◽  
Mohammed M. Kotb ◽  
Usama Farghaly Abdel-Hamid ◽  
Yousif Tarek El-Gammal
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Nerve Transfer ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Brachial Plexus Avulsion

scholarly journals 821: Long term outcome of children with obstetric brachial plexus palsy

2016 ◽  
Vol 214 (1) ◽  
pp. S427-S428
Author(s):  
Sivan Zuarez-Easton ◽  
Noah Zafran ◽  
Gali Garmi ◽  
Shmuel Edelstein ◽  
Zohar Nachum ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Palsy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Obstetric Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus

External Rotation as a Result of Suprascapular Nerve Neurotization in Obstetric Brachial Plexus Lesions

Neurosurgery ◽  
2005 ◽  
Vol 57 (3) ◽  
pp. 530-537 ◽  
Author(s):  
Willem Pondaag ◽  
Ralph de Boer ◽  
Marie S. van Wijlen-Hempel ◽  
Sonja M. Hofstede-Buitenhuis ◽  
Martijn J.A. Malessy
Keyword(s):  
Brachial Plexus ◽  
External Rotation ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Accessory Nerve ◽  
Nerve Grafting ◽  
Infraspinatus Muscle ◽  
Significant Difference ◽  
Obstetric Brachial Plexus ◽  
Grafting From

ABSTRACT OBJECTIVE: Obstetric brachial plexus lesions may cause lifelong limitations of upper limb function. Nerve repair is widely advocated in infants who do not show spontaneous recovery. Typically, the suprascapular nerve (SSN) is involved in the lesion. Neurotization of the SSN routinely is performed, aiming at reinnervation of the infraspinatus muscle to restore external rotation. The results after SSN neurotization have not, as yet, been studied in detail; therefore, this study was undertaken. Of special interest was the comparison of two commonly applied SSN neurotization procedures: nerve grafting from C5 versus nerve transfer of the accessory nerve. METHODS: Infants with obstetric brachial plexus lesions after nerve grafting of C5 to the SSN (n = 65) or nerve transfer of the accessory nerve to the SSN (n = 21) were selected for retrospective analysis after a mean follow-up period of 3 years. Outcome was expressed in degrees of true glenohumeral external rotation. This was defined as the angle between the position of the 90 degrees (actively or passively) flexed elbow resting against the abdomen and the position of the flexed elbow after external rotation with the upper arm held in adduction by the investigator. This movement can be executed only by infraspinatus muscle contraction. In addition, functional external rotation was evaluated by testing the ability to reach the mouth and the back of the head. RESULTS: Only 17 (20%) of the 86 patients reached more than 20 degrees of external rotation, whereas 35 (41%) were unable to perform true external rotation. There was no statistically significant difference between nerve grafting from C5 and extraplexal nerve transfer using the accessory nerve. Functional scores showed that 88% can reach the mouth and that 75% can reach the head. CONCLUSION: The restoration of a fair range of true glenohumeral external rotation after neurotization of the SSN in infants with obstetric brachial plexus lesions, whether by grafting from C5 or by nerve transfer of the accessory nerve, is disappointingly low. However, it seems that compensatory techniques contribute to effectuate a considerable range of movement.

scholarly journals POS1276 LONG TERM OUTCOME OF MULTIPLE ULTRASOUND GUIDED SUPRASCAPULAR NERVE BLOCK IN TREATMENT OF FROZEN SHOULDER IN DIABETIC PATIENTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 922.2-922
Author(s):  
M. A. Mortada ◽  
R. Hassan ◽  
Y. A. Amer
Keyword(s):  
Nerve Block ◽  
External Rotation ◽  
Frozen Shoulder ◽  
Suprascapular Nerve ◽  
Diabetic Patients ◽  
Ultrasound Guided ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Suprascapular Nerve Block

Background:Frozen shoulder is prevalent among diabetic patients, and usually has aggressive course, with more tendency to be bilateral and resistant to treatment. Suprascapular nerve block (SSNB) is used with increasing frequency by anesthetists and rheumatologists in the management of frozen shoulder. We previously introduced a protocol of nine injections for SSNB with better short term outcome than single SSNB injection (1). Long term outcome of SSNB in management of frozen shoulder is still not detected.Objectives:To evaluate the long term effect of multiple (nine) ultrasound guided supra-scapular nerve block in treatment of diabetic frozen shoulder.Methods:A retrospective cohort study followed up 40 diabetic patients who received a course of ultrasound guided multiple supra-scapular nerve block (9 injections) on 2014. In this study we retrospectively assessed the patients from previously recorded data at a mean duration of 6 years after completing the 9 injection course SSNB clinically by measuring the shoulder active range of motion (using a goniometer in three planes: abduction, internal, and external rotation). Visual analogue scale and Functional assessment by shoulder pain and disability index (SPADI).Results:Thirty four patients (85% of original cohort) completed the long term follow up.The patients were 19 (55.9%) females, 60.6 y mean age, and the mean of disease duration was 85.6 months. The majority of patients (33 patients 97.05%) continues improvement and gained within normal complete range of motions in all directions and excellent grades of shoulder function (Table 1).Table 1.Clinical ParametersAt base lineAt 4 monthsLast follow up at (72months±4)**P valueSPADI pain score (100)(68.8 ± 0.5)a(10.3 ± 7.4)b(0.9±1.9)c0.00*SPADI disability score (100)(69.2 ± 7.7)a(6.25 ± 2.25)b(0.4±0.8)c0.00*SPADI total (100)(69.1 ± 8.5)a(8.15 ± 5.4)b(1.1±0.9)c0.00*Patient global assessment (100)(90.2 ± 8.2)a(8.2 ± 4.2)b(0.4±2.1)c0.00*Night pain (100)(55.4±10.2)a(10.3 ± 4.9)b(2.3±1.1)c0.00*Abduction (180°)(77.5 ± 4.7)a(170.3 ± 10.3)b(174.2±6.2)b0.00*External rotation (100 °)(46 ± 12.6)a(80.1 ± 10.2)b(86.4±10.3)b0.00*Internal rotation (70 °)(34.5 ± 2.4)a(55.4 ± 10.1)b(60.2±9.5)b0.00** P <0.05 there was a statistical significant difference•A,b,c--- the alphabet of different symbols ---means a significant statistical difference between groupsSPADI: shoulder pain and disability indexConclusion:The multiple injection courses for supra-scapular nerve block has an excellent long term efficacy as treatment of diabetic frozen shoulder. This method should be the treatment of choice in patients of diabetic frozen shoulder who do not respond to physiotherapy.References:[1]Mortada, M. A., Ezzeldin, N., Abbas, S. F., Ammar, H. A. & Salama, N. A. Multiple versus single ultrasound guided suprascapular nerve block in treatment of frozen shoulder in diabetic patients. J. Back Musculoskelet. Rehabil. 30, 537–542 (2017).Disclosure of Interests:None declared

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