Axillary Nerve Injury

2018 ◽  
Author(s):  
Russell A. Payne ◽  
Elias B. Rizk
Keyword(s):  
Nerve Injury ◽  
Surgical Repair ◽  
Sports Injuries ◽  
External Rotation ◽  
Nerve Repair ◽  
Nerve Transfer ◽  
Axillary Nerve ◽  
Nerve Grafting ◽  
Surgical Exploration ◽  
Direct Nerve

Axillary nerve injury has been associated with sports injuries, especially those involving anterior shoulder dislocation. The nerve injury leads to weakness of the deltoid and teres minor muscles, which impairs abduction and external rotation of the arm at the shoulder. Electrodiagnostic studies are helpful for determining extent of reinnervation and recovery after injury. In the absence of clinical or electrodiagnostic signs of recovery 3 to 6 months after injury, it is appropriate to offer surgical exploration. The options for surgical repair include direct nerve repair, nerve grafting, and nerve transfer. In appropriately selected individuals, outcomes are favorable.

Nerve transfers for peripheral nerve injury in the upper limb

2019 ◽  
Vol 101-B (2) ◽  
pp. 124-131 ◽  
Author(s):  
J. Isaacs ◽  
A. R. Cochran
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Upper Limb ◽  
Nerve Repair ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Axillary Nerve ◽  
Nerve Transfers ◽  
Sensory Recovery ◽  
Potential Benefits

Nerve transfer has become a common and often effective reconstructive strategy for proximal and complex peripheral nerve injuries of the upper limb. This case-based discussion explores the principles and potential benefits of nerve transfer surgery and offers in-depth discussion of several established and valuable techniques including: motor transfer for elbow flexion after musculocutaneous nerve injury, deltoid reanimation for axillary nerve palsy, intrinsic re-innervation following proximal ulnar nerve repair, and critical sensory recovery despite non-reconstructable median nerve lesions.

scholarly journals Comparison of Nerve Transfer and Nerve Grafting for Restoration of External Rotation of Shoulder Function in Traumatic Brachial Plexus Injuries

2017 ◽  
Vol 42 (9) ◽  
pp. S32-S33
Author(s):  
Nina Suh ◽  
Eric R. Wagner ◽  
Michelle Kircher ◽  
Robert Spinner ◽  
Allen T. Bishop ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
External Rotation ◽  
Nerve Transfer ◽  
Shoulder Function ◽  
Nerve Grafting

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

scholarly journals Surgically relevant anatomy of the axillary and radial nerves in relation to the latissimus dorsi tendon in variable shoulder positions: A cadaveric study

2019 ◽  
Vol 12 (1) ◽  
pp. 24-30
Author(s):  
Stephen Gates ◽  
Brian Sager ◽  
Garen Collett ◽  
Avneesh Chhabra ◽  
Michael Khazzam
Keyword(s):  
Internal Rotation ◽  
Nerve Injury ◽  
Radial Nerve ◽  
Latissimus Dorsi ◽  
External Rotation ◽  
Axillary Nerve ◽  
Dynamic Nature ◽  
Iatrogenic Nerve Injury ◽  
Relationship Of ◽  
The Relationship

Background The purpose of this study was to define the relationship of the axillary and radial nerves, particularly how these are affected with changing arm position. Methods Twenty cadaveric shoulders were dissected, identifying the axillary and radial nerves. Distances between the latissimus dorsi tendon and these nerves were recorded in different shoulder positions. Positions included adduction/neutral rotation, abduction/neutral rotation for the axillary nerve, adduction/internal rotation, adduction/neutral rotation, adduction/external rotation, and abduction/external rotation for the radial nerve. Results Width of the latissimus tendon at its humeral insertion was 29.3 ± 5.7 mm. Mean distance from the latissimus insertion to the axillary nerve in adduction/neutral rotation was 24.2 ± 7.1 mm, the distance increased to 41.1 ± 9.8 mm in abduction/neutral rotation. Mean distance from the latissimus insertion to the radial nerve was 15.3 ± 5.5 mm with adduction/internal rotation, 25.8 ± 6.9 mm in adduction/neutral rotation, and 39.5 ± 6.8 mm in adduction/external rotation. Mean distance increased with abduction/external rotated 51.1 ± 7.4 mm. Conclusions Knowing the axillary and radial nerve locations relative to the latissimus dorsi tendon decreases the risk of iatrogenic nerve injury. Understanding the dynamic nature of these nerves related to different shoulder positions is critical to avoid complications.

Reconstruction of the spinal accessory nerve with selective fascicular nerve transfer of the upper trunk

2019 ◽  
Vol 31 (1) ◽  
pp. 133-138 ◽  
Author(s):  
Johannes A. Mayer ◽  
Laura A. Hruby ◽  
Stefan Salminger ◽  
Gerd Bodner ◽  
Oskar C. Aszmann
Keyword(s):  
Brachial Plexus ◽  
Nerve Repair ◽  
Nerve Transfer ◽  
Axillary Nerve ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Nerve Function ◽  
Analog Scale ◽  
Spinal Accessory ◽  
Active Range Of Motion

OBJECTIVESpinal accessory nerve palsy is frequently caused by iatrogenic damage during neck surgery in the posterior triangle of the neck. Due to late presentation, treatment regularly necessitates nerve grafts, which often results in a poor outcome of trapezius function due to long regeneration distances. Here, the authors report a distal nerve transfer using fascicles of the upper trunk related to axillary nerve function for reinnervation of the trapezius muscle.METHODSFive cases are presented in which accessory nerve lesions were reconstructed using selective fascicular nerve transfers from the upper trunk of the brachial plexus. Outcomes were assessed at 20 ± 6 months (mean ± SD) after surgery, and active range of motion and pain levels using the visual analog scale were documented.RESULTSAll 5 patients regained good to excellent trapezius function (3 patients had grade M5, 2 patients had grade M4). The mean active range of motion in shoulder abduction improved from 55° ± 18° before to 151° ± 37° after nerve reconstruction. In all patients, unrestricted shoulder arm movement was restored with loss of scapular winging when abducting the arm. Average pain levels decreased from 6.8 to 0.8 on the visual analog scale and subsided in 4 of 5 patients.CONCLUSIONSRestoration of spinal accessory nerve function with selective fascicle transfers related to axillary nerve function from the upper trunk of the brachial plexus is a good and intuitive option for patients who do not qualify for primary nerve repair or present with a spontaneous idiopathic palsy. This concept circumvents the problem of long regeneration distances with direct nerve repair and has the advantage of cognitive synergy to the target function of shoulder movement.

scholarly journals Management of Brachial Plexus Injury in Adults

2008 ◽  
Vol 97 (4) ◽  
pp. 317-323 ◽  
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.

Double-Nerve Transfer to the Axillary Nerve in Traumatic Upper Trunk Brachial Plexus Injuries Using an Axillary Approach: Anatomical Description and Preliminary Case Series

2020 ◽  
Vol 19 (2) ◽  
pp. E131-E139 ◽  
Author(s):  
Thibault Lafosse ◽  
Thibault Gerosa ◽  
Julien Serane ◽  
Michael Bouyer ◽  
Emmanuel H Masmejean ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
External Rotation ◽  
Case Series ◽  
Nerve Transfer ◽  
Axillary Nerve ◽  
Motor Deficit ◽  
Motor Branch ◽  
Axillary Approach ◽  
Nerve Transfers ◽  
Teres Minor

Abstract BACKGROUND Restoration of shoulder external rotation remains challenging in patients with C5/C6 brachial plexus injuries (BPI). OBJECTIVE To describe a double-nerve transfer to the axillary nerve (AN), targeting both its anterior and posterior motor branches, through an axillary route. METHODS A total of 10 fresh-frozen cadaveric brachial plexuses were dissected. Using an axillary approach, the infraclavicular brachial plexus terminal branches were exposed, including the axillary, ulnar, and radial nerves. Under microscopic magnification, the triceps long head motor branch (TLHMB), anteromedial fascicles of the ulnar nerve (UF), the anterior motor branch of the axillary nerve (AAMB), and the teres minor motor branch (TMMB) were dissected and transected to simulate 2 nerve transfers, THLMB-AAMB and UF-TMMB. Several anatomical criteria were assessed, including the overlaps between fascicles when placed side-by-side. Six patients with C5/C6 BPI were then operated on using this technique. RESULTS TLHMB-AAMB and UF-TMMB transfers could be simulated in all specimens, with mean overlaps of 37.1 mm and 6.5 mm, respectively. After a mean follow-up of 23 mo, all patients had recovered grade-3 strength or more in the deltoid and teres minor muscles. Mean active shoulder flexion, abduction, and external rotation with the arm 90° abducted were of 128°, 117°, and 51°, respectively. No postoperative motor deficit was found in the UF territory. CONCLUSION A double-nerve transfer, based on radial and ulnar fascicles, appears to be an adequate option to reanimate both motor branches of the AN, providing satisfactory shoulder active elevations and external rotation in C5/C6 BPI patients.

SURGICAL TREATMENT OF POSTERIOR INTEROSSEOUS NERVE SYNDROME

Hand Surgery ◽  
1996 ◽  
Vol 01 (02) ◽  
pp. 107-112
Author(s):  
Sheng-Mou Hou ◽  
Jyh-Horng Wang ◽  
Jui-Sheng Sun
Keyword(s):  
Surgical Treatment ◽  
Nerve Injury ◽  
Sural Nerve ◽  
Tendon Transfer ◽  
Nerve Repair ◽  
Posterior Interosseous Nerve ◽  
Nerve Grafting ◽  
Motor Power ◽  
Iatrogenic Nerve Injury ◽  
Posterior Interosseous Nerve Syndrome

Sixteen patients were operated on consecutively for palsy of the posterior interosseous nerve. The aetiologies were traumatic in 12 patients and non-traumatic in four. Operative neurolysis was done in six cases. Neurorrhaphy with sural nerve grafting was performed in two cases. Tendon transfer was done in eight cases. Relief of compression has the best result followed by nerve repair. Iatrogenic nerve injury after radial plating carried the worst prognosis. Although motor power was not normal after surgery, tendon transfer still provided a useful hand with residual extension lag of the fingers. The prognosis of operative treatment of posterior interosseous nerve syndrome depends mainly on its aetiology.

Direct repair (nerve grafting), neurotization, and end-to-side neurorrhaphy in the treatment of brachial plexus injury

2007 ◽  
Vol 106 (3) ◽  
pp. 391-399 ◽  
Author(s):  
Pavel Haninec ◽  
Filip Šámal ◽  
Robert Tomáš ◽  
Ladislav Houstava ◽  
Petr Dubový
Keyword(s):  
Brachial Plexus ◽  
Success Rate ◽  
Nerve Repair ◽  
Functional Results ◽  
Axillary Nerve ◽  
Long Term Results ◽  
Nerve Grafting ◽  
Direct Repair ◽  
Better Than

Object The authors present the long-term results of nerve grafting and neurotization procedures in their group of patients with brachial plexus injuries and compare the results of “classic” methods of nerve repair with those of end-to-side neurorrhaphy. Methods Between 1994 and 2006, direct repair (nerve grafting), neurotization, and end-to-side neurorrhaphy were performed in 168 patients, 95 of whom were followed up for at least 2 years after surgery. Successful results were achieved in 79% of cases after direct repair and in 56% of cases after end-to-end neurotization. The results of neurotization depended on the type of the donor nerve used. In patients who underwent neurotization of the axillary and the musculocutaneous nerves, the use of intraplexal nerves (motor branches of the brachial plexus) as donors of motor fibers was associated with a significantly higher success rate than the use of extraplexal nerves (81% compared with 49%, respectively, p = 0.003). Because of poor functional results of axillary nerve neurotization using extraplexal nerves (success rate 47.4%), the authors used end-to-side neurorrhaphy in 14 cases of incomplete avulsion. The success rate for end-to-side neurorrhaphy using the axillary nerve as a recipient was 64.3%, similar to that for neurotization using intraplexal nerves (68.4%) and better than that achieved using extraplexal nerves (47.4%, p = 0.19). Conclusions End-to-side neurorrhaphy offers an advantage over classic neurotization in not requiring sacrifice of any of the surrounding nerves or the fascicles of the ulnar nerve. Typical synkinesis of muscle contraction innervated by the recipient nerve with contraction of muscles innervated by the donor was observed in patients after end-to-side neurorrhaphy.

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