Evaluation of Single-, Double-, and Triple-Nerve Transfers for Shoulder Abduction in 90 Patients with Supraclavicular Brachial Plexus Injury

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.

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Nerve Reconstruction and Tendon Transfers for Treatment of Brachial Plexus Injuries

10.2310/ps.10067 ◽

2019 ◽

Author(s):

Christopher J. Dy ◽

David M. Brogan ◽

Martin I. Boyer ◽

Carol B. Loeb ◽

Jerome T. Loeb

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Injury ◽

Treatment Strategies ◽

Shoulder Abduction ◽

Nerve Grafting ◽

Nerve Reconstruction ◽

Reconstructive Procedures ◽

Tendon Transfers ◽

Neurologic Recovery ◽

Nerve Transfers

The complexity of each brachial plexus injury (BPI) pattern and physiologic limitations of nerve regeneration create challenges for BPI patients and their surgeons. Detailed assessment via physical examination, electrodiagnostic studies, and advanced imaging can aid the surgeon in predicting the prognosis for each patient’s neurologic recovery and provide an outline for reconstructive priorities. Surgical exploration of the brachial plexus confirms the injury pattern and guides the overall treatment strategies. A multimodal reconstructive strategy including nerve grafting, extraplexal nerve transfers, distal intraplexal nerve transfers, and free-functioning muscle transfers is designed for each patient to accomplish the goals of providing a pain-free helper hand. Additional reconstructive procedures such as tendon transfers and selective joint arthrodeses are used after the results of the initial reconstructive efforts have been declared. Beyond the neurologic components of BPI, the surgeon must be attuned to the social and psychological sequelae of this devastating injury. This review contains 10 figures, 1 table, and 60 references. Key Words: brachial plexus injury, elbow flexion, free-functioning muscle transfer, nerve grafting, nerve transfer, reconstruction, shoulder abduction, , tendon transfer

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Shoulder abduction reconstruction for C5–7 avulsion brachial plexus injury by dual nerve transfers: spinal accessory to suprascapular nerve and partial median or ulnar to axillary nerve

Journal of Plastic Surgery and Hand Surgery ◽

10.1080/2000656x.2021.1934842 ◽

2021 ◽

pp. 1-6

Author(s):

Gavrielle Hui-Ying Kang ◽

Fok-Chuan Yong

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Injury ◽

Suprascapular Nerve ◽

Axillary Nerve ◽

Shoulder Abduction ◽

Spinal Accessory ◽

Nerve Transfers

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Comparing the Efficacy of Triple Nerve Transfers with Nerve Graft Reconstruction in Upper Trunk Obstetric Brachial Plexus Injury

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000003668 ◽

2017 ◽

Vol 140 (4) ◽

pp. 747-756 ◽

Cited By ~ 10

Author(s):

Kathleen M. O’Grady ◽

Hollie A. Power ◽

Jaret L. Olson ◽

Michael J. Morhart ◽

A. Robertson Harrop ◽

...

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Injury ◽

Nerve Graft ◽

Nerve Transfers ◽

Obstetric Brachial Plexus ◽

Graft Reconstruction ◽

Obstetric Brachial Plexus Injury

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Comparative study of phrenic nerve transfers with and without nerve graft for elbow flexion after global brachial plexus injury

Injury ◽

10.1016/j.injury.2012.12.013 ◽

2014 ◽

Vol 45 (1) ◽

pp. 227-231 ◽

Cited By ~ 16

Author(s):

Yuzhou Liu ◽

Jie Lao ◽

Kaiming Gao ◽

Yudong Gu ◽

Xin Zhao

Keyword(s):

Comparative Study ◽

Brachial Plexus ◽

Phrenic Nerve ◽

Brachial Plexus Injury ◽

Elbow Flexion ◽

Nerve Graft ◽

Nerve Transfers

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

Neurosurgery ◽

10.1093/neuros/nyy335 ◽

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.

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Upper brachial plexus injury in adults: comparative effectiveness of different repair techniques

Journal of Neurosurgery ◽

10.3171/2014.9.jns132823 ◽

2015 ◽

Vol 122 (1) ◽

pp. 195-201 ◽

Cited By ~ 48

Author(s):

Zarina S. Ali ◽

Gregory G. Heuer ◽

Ryan W. F. Faught ◽

Shriya H. Kaneriya ◽

Umar A. Sheikh ◽

...

Keyword(s):

Brachial Plexus ◽

Controlled Trial ◽

Treatment Strategies ◽

Nerve Transfer ◽

Elbow Flexion ◽

Surgical Approaches ◽

Shoulder Abduction ◽

Nerve Grafting ◽

Nerve Transfers ◽

Repair Techniques

OBJECT Adult upper trunk brachial plexus injuries result in significant disability. Several surgical treatment strategies exist, including nerve grafting, nerve transfers, and a combination of both approaches. However, no existing data clearly indicate the most successful strategy for restoring elbow flexion and shoulder abduction in these patients. The authors reviewed the literature to compare outcomes of the three surgical repair techniques listed above to determine the optimal approach to traumatic injury to the upper brachial plexus in adults. METHODS Both PubMed and EMBASE databases were searched for English-language articles containing the MeSH topic “brachial plexus” in conjunction with the word “injury” or “trauma” in the title and “surgery” or “repair” as a MeSH subheading or in the title, excluding pediatric articles and those articles limited to avulsions. The search was also limited to articles published after 1990 and containing at least 10 operated cases involving upper brachial plexus injuries. The search was supplemented with articles obtained through the “Related Articles” feature on PubMed and the bibliographies of selected publications. From the articles was collected information on the operation performed, number of operated cases, mean subject ages, sex distribution, interval between injury and surgery, source of nerve transfers, mean duration of follow-up, year of publication, and percentage of operative success in terms of elbow flexion and shoulder abduction of the injured limb. The recovery of elbow flexion and shoulder abduction was separately analyzed. A subanalysis was also performed to assess the recovery of elbow flexion following various neurotization techniques. RESULTS As regards the restoration of elbow flexion, nerve grafting led to significantly better outcomes than either nerve transfer or the combined techniques (F = 4.71, p = 0.0097). However, separating the Oberlin procedure from other neurotization techniques revealed that the former was significantly more successful (F = 82.82, p < 0.001). Moreover, in comparing the Oberlin procedure to nerve grafting or combined procedures, again the former was significantly more successful than either of the latter two approaches (F = 53.14; p < 0.001). In the restoration of shoulder abduction, nerve transfer was significantly more successful than the combined procedure (p = 0.046), which in turn was significantly better than nerve grafting procedures (F = 5.53, p = 0.0044). CONCLUSIONS According to data in this study, in upper trunk brachial plexus injuries in adults, the Oberlin procedure and nerve transfers are the more successful approaches to restore elbow flexion and shoulder abduction, respectively, compared with nerve grafting or combined techniques. A prospective, randomized controlled trial would be necessary to fully elucidate differences in outcome among the various surgical approaches.

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