Lower Trapezius Muscle Transfer for Elbow Extension Reconstruction After Failed Nerve Transfer for Tetraplegia

Elbow extension is a prerequisite for adequate hand position. Muscle transfers are often employed in partial injuries of the brachial plexus, when neurological surgery is unlikely to achieve desired results. The posterior deltoid and latissimus dorsi are the two muscles most commonly used for transfer but there are few alternatives when these two muscles are paralysed. We now report on the successful transfer of the lower trapezius muscle to reconstruct triceps function in three patients with longstanding lesions of the brachial plexus that had not been previously treated surgically.

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Trapezius Muscle Transfer for Restoration of Elbow Extension in a Traumatic Brachial Plexus Injury

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2018.02.005 ◽

2018 ◽

Vol 43 (9) ◽

pp. 872.e1-872.e6 ◽

Cited By ~ 3

Author(s):

Hamza M. Alrabai ◽

Martin G. Gesheff ◽

Ahmed I. Hammouda ◽

Janet D. Conway

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Injury ◽

Trapezius Muscle ◽

Elbow Extension ◽

Muscle Transfer

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Upper and lower trapezius muscle transfer to restore shoulder abduction and external rotation in longstanding upper type palsies of the brachial plexus in adults

Microsurgery ◽

10.1002/micr.20838 ◽

2010 ◽

Vol 31 (4) ◽

pp. 263-267 ◽

Cited By ~ 22

Author(s):

Jayme Augusto Bertelli

Keyword(s):

Brachial Plexus ◽

External Rotation ◽

Trapezius Muscle ◽

Shoulder Abduction ◽

Muscle Transfer ◽

Lower Trapezius

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Transfer of a Motor Fascicle From the Ulnar Nerve to the Branch of the Radial Nerve Destined to the Long Head of the Triceps for Restoration of Elbow Extension in Brachial Plexus Surgery

Neurosurgery ◽

10.1227/neu.0b013e31822ac120 ◽

2011 ◽

Vol 70 (2) ◽

pp. E516-E520 ◽

Cited By ~ 11

Author(s):

Leandro Pretto Flores

Keyword(s):

Computed Tomography ◽

Brachial Plexus ◽

Ulnar Nerve ◽

Radial Nerve ◽

Nerve Transfer ◽

Elbow Flexion ◽

Shoulder Abduction ◽

Elbow Extension ◽

Long Head ◽

Brachial Plexus Surgery

Abstract BACKGROUND AND IMPORTANCE: Restoration of elbow extension has not been considered of much importance regarding functional outcomes in brachial plexus surgery; however, the flexion of the elbow joint is only fully effective if the motion can be stabilized, what can be achieved solely if the triceps brachii is coactivated. To present a novel nerve transfer of a healthy motor fascicle from the ulnar nerve to the nerve of the long head of the triceps to restore the elbow extension function in brachial plexus injuries involving the upper and middle trunks. CLINICAL PRESENTATION: Case 1 is a 32-year-old man sustaining a right brachial extended upper plexus injury in a motorcycle accident 5 months before admission. The computed tomography myelogram demonstrated avulsion of the C5 and C6 roots. Case 2 is a 24-year-old man who sustained a C5-C7 injury to the left brachial plexus in a traffic accident 4 months before admission. Computed tomography myelogram demonstrated signs of C6 and C7 root avulsion. The technique included an incision at the medial border of the biceps, in the proximal third of the involved arm, followed by identification of the ulnar nerve, the radial nerve, and the branch to the long head of the triceps. The proximal stump of a motor fascicle from the ulnar nerve was sutured directly to the distal stump of the nerve of the long head of the triceps. Techniques to restore elbow flexion and shoulder abduction were applied in both cases. Triceps strength Medical Research Council M4 grade was obtained in both cases. CONCLUSION: The attempted nerve transfer was effective for restoration of elbow extension in primary brachial plexus surgery; however, it should be selected only for cases in which other reliable donor nerves were used to restore elbow flexion.

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Comparison of the Electromyographic Activity in the Lower Trapezius Muscle According to Four Different Types of Exercises in Healthy Adults

The Journal of Korean Physical Therapy ◽

10.18857/jkpt.2019.31.2.134 ◽

2019 ◽

Vol 31 (2) ◽

pp. 134-139 ◽

Cited By ~ 1

Author(s):

Gyeong Ju Seo ◽

Ji Won Park ◽

Yonghyun Kwon

Keyword(s):

Trapezius Muscle ◽

Healthy Adults ◽

Electromyographic Activity ◽

Different Types ◽

Lower Trapezius

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Rehabilitative Ultrasound Imaging of the Lower Trapezius Muscle: Technical Description and Reliability

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2007.2446 ◽

2007 ◽

Vol 37 (10) ◽

pp. 620-626 ◽

Cited By ~ 47

Author(s):

Cliona O'Sullivan ◽

Susanna Bentman ◽

Kathleen Bennett ◽

Maria Stokes

Keyword(s):

Ultrasound Imaging ◽

Trapezius Muscle ◽

Technical Description ◽

Lower Trapezius

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Improved Technique for Harvesting the Accessory Nerve for Transfer in Brachial Plexus Injuries

Operative Neurosurgery ◽

10.1227/01.neu.0000205286.70890.27 ◽

2006 ◽

Vol 58 (suppl_4) ◽

pp. ONS-366-ONS-370 ◽

Cited By ~ 6

Author(s):

Jayme Augusto Bertelli ◽

Marcos Flavio Ghizoni

Keyword(s):

Brachial Plexus ◽

Lymphatic Vessels ◽

Trapezius Muscle ◽

Nerve Transfer ◽

Suprascapular Nerve ◽

Accessory Nerve ◽

Fat Tissue ◽

Anterior Border ◽

Improved Technique ◽

Nerve Identification

Abstract Objective: The accessory nerve is frequently used as a donor for nerve transfer in brachial plexus injuries. In currently available techniques, nerve identification and dissection is difficult because fat tissue, lymphatic vessels, and blood vessels surround the nerve. We propose a technique for location and dissection of the accessory nerve between the deep cervical fascia and the trapezius muscle. Methods: Twenty-eight patients with brachial plexus palsy had the accessory nerve surgically transplanted to the suprascapular nerve. To harvest the accessory nerve, the anterior border of the trapezius muscle was located 2 to 3 cm above the clavicle. The fascia over the trapezius muscle was incised and detached from the anterior surface of the muscle, initially, close to the clavicle, then proximally. The trapezius muscle was detached from the clavicle for 3 to 4 cm. The accessory nerve and its branches entering the trapezius muscle were identified. The accessory nerve was sectioned as distally as possible. To allow for accessory nerve mobilization, one or two proximal branches to the trapezius muscle were cut. The most proximal branch was always identified and preserved. A tunnel was created in the detached fascia, and the accessory nerve was passed through this tunnel to the brachial plexus. Results: In all of the cases, the accessory nerve was easily identified under direct vision, without the use of electric stimulation. Direct coaptation of the accessory nerve with the suprascapular nerve was possible in all patients. Conclusion: The technique proposed here for harvesting the accessory nerve for transfer made its identification and dissection easier.

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Management of Brachial Plexus Injury in Adults

Scandinavian Journal of Surgery ◽

10.1177/145749690809700408 ◽

2008 ◽

Vol 97 (4) ◽

pp. 317-323 ◽

Cited By ~ 45

Author(s):

P. Songcharoen

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Injury ◽

Nerve Repair ◽

Hand Function ◽

Nerve Transfer ◽

Nerve Grafting ◽

Muscle Transfer ◽

Nerve Roots ◽

Elbow Function ◽

Motorcycle Accidents

Brachial plexus injury in adults is commonly caused by motorcycle accidents. Surgical management consists of nerve repair and nerve grafting for extraforaminal nerve root or trunk injury, and of neurotization or nerve transfer for nerve roots avulsion. In general, the results regarding restoration of shoulder and elbow function are good but reinnervation of the forearm muscles is less than safisfactory in respect to restoration of hand function. Functioning free muscle transfer in combination with selective nerve transfer is a reasonable alternative surgical procedure.

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