scholarly journals Pearls and Pitfalls of Phrenic Nerve Transfer for Shoulder Reconstruction in Brachial Plexus Injury

2021 ◽  
Vol 16 (01) ◽  
pp. e1-e9
Author(s):  
Kazuteru Doi ◽  
Sei Haw Sem ◽  
Bipin Ghanghurde ◽  
Yasunori Hattori ◽  
Sotetsu Sakamoto
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Functional Outcomes ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Pulmonary Complications ◽  
Predisposing Factors ◽  
Shoulder Range Of Motion ◽  
Shoulder Reconstruction

Abstract Objectives The purpose of this study was to report the functional outcomes of phrenic nerve transfer (PNT) to suprascapular nerve (SSN) for shoulder reconstruction in brachial plexus injury (BPI) patients with total and C5–8 palsies, and its pulmonary complications. Methods Forty-four out of 127 BPI patients with total and C5–8 palsies who underwent PNT to SSN for shoulder reconstruction were evaluated for functional outcomes in comparison with other types of nerve transfers. Their pulmonary function was analyzed using vital capacity in the percentage of predicted value and Hugh-Jones (HJ) breathless classification. The predisposing factors to develop pulmonary complications in those patients were examined as well. Results PNT to SSN provided a better shoulder range of motion significantly as compared with nerve transfer from C5 root and contralateral C7. The results between PNT and spinal accessory nerve transfer to SSN were comparable in all directions of shoulder motions. There were no significant respiratory symptoms in majority of the patients including six patients who were classified into grade 2 HJ breathlessness grading. Two predisposing factors for poorer pulmonary performance were identified, which were age and body mass index, with cut-off values of younger than 32 years old and less than 23, respectively. Conclusions PNT to SSN can be a reliable reconstructive procedure in restoration of shoulder function in BPI patients with total or C5–8 palsy. The postoperative pulmonary complications can be prevented with vigilant patient selection.

Nerve Transfer Is Superior to Nerve Grafting for Suprascapular Nerve Reconstruction in Obstetrical Brachial Plexus Birth Injury: A Meta-Analysis

Hand ◽  
2021 ◽  
pp. 155894472110306
Author(s):  
Kevin J. Nickel ◽  
Alexander Morzycki ◽  
Ralph Hsiao ◽  
Michael J. Morhart ◽  
Jaret L. Olson
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
External Rotation ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Cochrane Library ◽  
Nerve Grafting ◽  
Level Of Evidence ◽  
Optimal Method ◽  
Shoulder External Rotation

Background Restoration of shoulder function in obstetrical brachial plexus injury is paramount. There remains debate as to the optimal method of upper trunk reconstruction. The purpose of this study was to test the hypothesis that spinal accessory nerve to suprascapular nerve transfer leads to improved shoulder external rotation relative to sural nerve grafting. Methods A systematic review of Medline, EMBASE, EBSCO CINAHL, SCOPUS, Cochrane Library, and TRIP Pro from inception was conducted. Our primary outcome was shoulder external rotation. Results Four studies were included. Nerve transfer was associated with greater shoulder external rotation relative to nerve grafting (mean difference: 0.82 AMS 95% confidence interval [CI]: 0.27-1.36, P < .005). Patients undergoing nerve grafting were more likely to undergo a secondary shoulder stabilizing procedure (odds ratio [OR]: 1.27, 95% CI: 0.8376-1.9268). Conclusion In obstetrical brachial plexus injury, nerve transfer is associated with improved shoulder external rotation and a lower rate of secondary shoulder surgery. Level of Evidence Level III; Therapeutic

Minimum Ten-Year Outcomes of Partial Ulnar Nerve Transfer for Restoration of Elbow Flexion in Patients with Upper Brachial Plexus Injury

2019 ◽  
Vol 24 (03) ◽  
pp. 283-288
Author(s):  
Yusuke Nagano ◽  
Daisuke Kawamura ◽  
Alaa Terkawi ◽  
Atsushi Urita ◽  
Yuichiro Matsui ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Functional Outcomes ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
The Mean ◽  
Flexion Strength

Background: Partial ulnar nerve transfer to the biceps motor branch of the musculocutaneous nerve (Oberlin’s transfer) is a successful approach to restore elbow flexion in patients with upper brachial plexus injury (BPI). However, there is no report on more than 10 years subjective and objective outcomes. The purpose of this study was to clarify the long-term outcomes of Oberlin’s transfer based on the objective evaluation of elbow flexion strength and subjective functional evaluation of patients. Methods: Six patients with BPI who underwent Oberlin’s transfer were reviewed retrospectively by their medical records. The mean age at surgery was 29.5 years, and the mean follow-up duration was 13 years. The objective functional outcomes were evaluated by biceps muscle strength using the Medical Research Council (MRC) grade at preoperative, postoperative, and final follow-up. The patient-derived subjective functional outcomes were evaluated using the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at final follow-up. Results: All patients had MRC grade 0 (M0) or 1 (M1) elbow flexion strength before operation. Four patients gained M4 postoperatively and maintained or increased muscle strength at the final follow-up. One patient gained M3 postoperatively and at the final follow-up. Although one patient achieved M4 postoperatively, the strength was reduced to M2 due to additional disorder. The mean score of QuickDASH was 36.5 (range, 7–71). Patients were divided into two groups; three patients had lower scores and the other three patients had higher scores of QuickDASH. Conclusions: Oberlin’s transfer is effective in the restoration of elbow flexion and can maintain the strength for more than 10 years. Patients with upper BPI with restored elbow flexion strength and no complicated nerve disorders have over ten-year subjective satisfaction.

scholarly journals Quantifying Real-World Upper-Limb Activity Via Patient-Initiated Movement After Nerve Reconstruction for Upper Brachial Plexus Injury

Neurosurgery ◽  
2018 ◽  
Vol 85 (3) ◽  
pp. 369-374
Author(s):  
Brandon W Smith ◽  
Kate W-C Chang ◽  
Serena J Saake ◽  
Lynda J-S Yang ◽  
Kevin C Chung ◽  
...  
Keyword(s):  
Pilot Study ◽  
Brachial Plexus ◽  
Range Of Motion ◽  
Real World ◽  
Functional Outcomes ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Shoulder Abduction ◽  
Patient Reported ◽  
Motion Detectors

Abstract BACKGROUND A critical concept in brachial plexus reconstruction is the accurate assessment of functional outcomes. The current standard for motor outcome assessment is clinician-elicited, outpatient clinic-based, serial evaluation of range of motion and muscle power. However, discrepancies exist between such clinical measurements and actual patient-initiated use. We employed emerging technology in the form of accelerometry-based motion detectors to quantify real-world arm use after brachial plexus surgery. OBJECTIVE To evaluate (1) the ability of accelerometry-based motion detectors to assess functional outcome and (2) the real-world arm use of patients after nerve transfer for brachial plexus injury, through a pilot study. METHODS Five male patients who underwent nerve transfer after brachial plexus injury wore bilateral motion detectors for 7 d. The patients also underwent range-of-motion evaluation and completed multiple patient-reported outcome surveys. RESULTS The average age of the recruits was 41 yr (±17 yr), and the average time from operation was 2 yr (±1 yr). The VT (time of use ratio) for the affected side compared to the unaffected side was 0.73 (±0.27), and the VM (magnitude ratio) was 0.63 (±0.59). VT strongly and positively correlated with shoulder flexion and shoulder abduction: 0.97 (P = .008) and 0.99 (P = .002), respectively. CONCLUSION Accelerometry-based activity monitors can successfully assess real-world functional outcomes after brachial plexus reconstruction. This pilot study demonstrates that patients after nerve transfer are utilizing their affected limbs significantly in daily activities and that recovery of shoulder function is critical.

Restoration of Shoulder Abduction in Brachial Plexus Injury with Phrenic Nerve Transfer

2000 ◽  
Vol 70 (11) ◽  
pp. 783-785 ◽  
Author(s):  
Adisak Sungpet ◽  
Chanyuth Suphachatwong ◽  
Viroj Kawinwonggowith
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Shoulder Abduction

scholarly journals Shoulder Arthrodesis versus Upper Trapezius Transfer for Traumatic Brachial Plexus Injury: A Proportional Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Dafang Zhang ◽  
Rohit Garg ◽  
Brandon E. Earp ◽  
Philip Blazar ◽  
George S. M. Dyer
Keyword(s):  
Brachial Plexus ◽  
Functional Outcome ◽  
Brachial Plexus Injury ◽  
Meta Analysis ◽  
Upper Trapezius ◽  
Shoulder Range Of Motion ◽  
Outcome Scores ◽  
Shoulder Arthrodesis ◽  
Shoulder Range ◽  
Shoulder Reconstruction

Shoulder arthrodesis and upper trapezius transfer are two surgical options for secondary shoulder reconstruction for traumatic brachial plexus injury (BPI). There is a lack of comparative evidence to guide the choice for one procedure over the other. The objectives of this study were to compare (1) rates of complications and reoperation and (2) shoulder range of motion and functional outcome scores following shoulder arthrodesis versus upper trapezius transfer for traumatic BPI. A systematic review and meta-analysis were conducted by a search of four databases of studies assessing shoulder arthrodesis and/or upper trapezius transfer for shoulder reconstruction following adult traumatic BPI. A proportional meta-analysis was performed using a random effects model in anticipation of unobserved heterogeneity. The final meta-analysis included 374 patients from 17 studies, including 232 patients from 11 studies on shoulder arthrodesis and 142 patients from 6 studies on upper trapezius transfer. Shoulder arthrodesis had higher rates of complications and reoperations than upper trapezius transfer for traumatic BPI, but these differences did not reach a statistical significance. Due to the limited sample size, variations in reporting, and study heterogeneity in the published literature, we were not able to draw conclusions regarding shoulder range of motion and functional outcome scores between these two procedures. Shoulder arthrodesis and upper trapezius transfer are both viable options for secondary shoulder reconstruction for traumatic BPI, but with different complications and reoperation profiles. Patients should be counseled on the risk of nonunion and humerus fracture following shoulder arthrodesis.

scholarly journals Outcome of double nerve transfer close to target muscle both for shoulder abduction and elbow flexion in early C5 –C6 Brachial Plexus injury.

2020 ◽  
Vol 27 (07) ◽  
pp. 1442-1447
Author(s):  
Husnain Khan ◽  
Muhammad Shafique ◽  
Zahid Iqbal Bhatti ◽  
Tehseen Ahmad Cheema
Keyword(s):  
Brachial Plexus ◽  
Posterior Approach ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Suprascapular Nerve ◽  
Axillary Nerve ◽  
Shoulder Abduction ◽  
Motor Branch ◽  
Nerve Transfers

Adult brachial plexus injury is a now a common problem due to high incidence of motorbike accidents. Among all types, C 5 and C6 (upper brachial plexus injury) is the most common. If the patient present within 6 months then nerve transfer is the preferred treatment. However, there are different options for nerve transfer and different approaches for surgery. Objectives: The objective of the study was to share our experience of nerve transfer close to target muscles in upper brachial plexus injury. Study Design: Quaisi experimental study. Setting: National Orthopaedic Hospital, Bahawalpur. Period: January 2015 to June 2018. Material & Methods: Total 32 patients were operated with isolated C5 and C6 injury. In all patients four nerve transfers were done. For shoulder abduction posterior approach was used and accessory to suprascapular nerve and one of motor branch of radial to axillary nerve were transferred. Modified Oberlin transfer was done for elbow flexion. Both shoulder abduction and elbow flexion was graded according to medical research council grading system. Results: After one year follow up more than 75% of the patients showed good to normal shoulder abduction and 87.50% showed good to normal elbow flexion. Residual Median nerve damage was noted only in two patients (6.25%). Conclusion: If there is no evidence of recovery up to three months early nerve transfer should be considered, ideal time is 3-6 months. Nerve transfer close to target muscle yields superior results. The shoulder stabilizers and abductors should ideally be innervated by double nerve transfer through posterior approach. Similarly double fascicular transfer (modified Oberlin) should be done for elbow flexion.

scholarly journals Use of contralateral spinal accessory nerve for ipsilateral suprascapular neurotization in global brachial plexus injury: a new technique

2016 ◽  
Vol 24 (1) ◽  
pp. 186-188 ◽  
Author(s):  
Prem Singh Bhandari ◽  
Prabal Deb
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Standard Technique ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Spinal Accessory ◽  
A New Technique ◽  
Additional Option

Nerve transfer between the spinal accessory nerve (SAN) and the suprascapular nerve (SSN) is a standard technique in shoulder reanimation. In cases of global brachial plexus injury, donor nerves are few and at times severely traumatized owing to extensive traction forces. This precludes the application of standard nerve transfer techniques. The authors offer the use of the contralateral SAN as an additional option in the reinnervation of an injured SSN in such circumstances. To the best of their knowledge, this is the first successful attempt of this technique to be reported in the literature.

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