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 Dorsal Scapular Nerve Transfer to Suprascapular Nerve

2017 ◽  
Vol 3 ◽  
pp. 2513826X1775111 ◽  
Author(s):  
Haley Augustine ◽  
Matthew Choi ◽  
James Bain
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
External Rotation ◽  
Full Range ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Shoulder Function ◽  
Accessory Nerve ◽  
Active Movement ◽  
Secondary Surgery

Background: Obstetrical brachial plexus injury involving the suprascapular nerve is conventionally treated using an accessory nerve transfer or grafting. In circumstances where the accessory nerve is unsuitable, transfer of nerves with redundant function may be an alternate method of restoring function. Methods: This case describes the surgical technique of restoring shoulder function by reinnervating the musculature of the suprascapular nerve with a dorsal scapular nerve transfer in a patient with an obstetrical brachial plexus injury. Results: At 15 months post-operatively, the patient shoulder movement improved from zero muscle contraction to full range of motion against gravity measured by the active movement scale. His composite mallet score was 23 out of 25, with perfect scores in abduction and external rotation. Secondary surgery was not required. Conclusions: This case demonstrates a novel alternative to suprascapular nerve reinnervation in circumstances where the accessory nerve is unavailable, damaged, or otherwise suboptimal. Successful results were achieved, thus warranting consideration in clinical practice as well as further exploration and study.

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.

Nerve graft versus nerve transfer for neonatal brachial plexus: shoulder outcomes

2021 ◽  
Vol 27 (1) ◽  
pp. 87-92
Author(s):  
Brandon W. Smith ◽  
Kate W. C. Chang ◽  
Sravanthi Koduri ◽  
Lynda J. S. Yang
Keyword(s):  
Brachial Plexus ◽  
Clinical Data ◽  
External Rotation ◽  
Nerve Transfer ◽  
Shoulder Function ◽  
Nerve Transfers ◽  
Shoulder Flexion ◽  
Significant Difference ◽  
Transfer Strategies ◽  
Shoulder External Rotation

OBJECTIVEThe decision-making in neonatal brachial plexus palsy (NBPP) treatment continues to have many areas in need of clarification. Graft repair was the gold standard until the introduction of nerve transfer strategies. Currently, there is conflicting evidence regarding outcomes in patients with nerve grafts versus nerve transfers in relation to shoulder function. The objective of this study was to further define the outcomes for reconstruction strategies in NBPP with a specific focus on the shoulder.METHODSA cohort of patients with NBPP and surgical repairs from a single center were reviewed. Demographic and standard clinical data, including imaging and electrodiagnostics, were gathered from a clinical database. Clinical data from physical therapy evaluations, including active and passive range of motion, were examined. Statistical analysis was performed on the available data.RESULTSForty-five patients met the inclusion criteria for this study, 19 with graft repair and 26 with nerve transfers. There were no significant differences in demographics between the two groups. Understandably, there were no patients in the nerve grafting group with preganglionic lesions, resulting in a difference in lesion type between the cohorts. There were no differences in preoperative shoulder function between the cohorts. Both groups reached statistically significant improvements in shoulder flexion and shoulder abduction. The nerve transfer group experienced a significant improvement in shoulder external rotation, from −78° to −28° (p = 0.0001), whereas a significant difference was not reached in the graft group. When compared between groups, there appeared to be a trend favoring nerve transfer in shoulder external rotation, with the graft patients improving by 17° and the transfer patients improving by 49° (p = 0.07).CONCLUSIONSIn NBPP, patients with shoulder weakness experience statistically significant improvements in shoulder flexion and abduction after graft repair or nerve transfer, and patients with nerve transfers additionally experience significant improvement in external rotation. With regard to shoulder external rotation, there appear to be some data supporting the use of nerve transfers.

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

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.

Anatomic study of the intercostal nerve transfer to the suprascapular nerve and a case report

2013 ◽  
Vol 39 (2) ◽  
pp. 194-198 ◽  
Author(s):  
S. Hu ◽  
B. Chu ◽  
J. Song ◽  
L. Chen
Keyword(s):  
Case Report ◽  
Brachial Plexus ◽  
External Rotation ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Intercostal Nerve ◽  
Accessory Nerve ◽  
Shoulder Abduction ◽  
Anatomical Basis ◽  
Intercostal Nerves

The purpose of this study was to investigate the anatomical basis of intercostal nerve transfer to the suprascapular nerve and provide a case report. Thoracic walls of 30 embalmed human cadavers were used to investigate the anatomical feasibility for neurotization of the suprascapular nerve with intercostal nerves in brachial plexus root avulsions. We found that the 3rd and 4th intercostal nerves could be transferred to the suprascapular nerve without a nerve graft. Based on the anatomical study, the 3rd and 4th intercostal nerves were transferred to the suprascapular nerve via the deltopectoral approach in a 42-year-old man who had had C5-7 root avulsions and partial injury of C8, T1 of the right brachial plexus. Thirty-two months postoperatively, the patient gained 30° of shoulder abduction and 45° of external rotation. This procedure provided us with a reliable and convenient method for shoulder function reconstruction after brachial plexus root avulsion accompanied with spinal accessory nerve injury. It can also be used when the accessory nerve is intact but needs to be preserved for better shoulder stability or possible future trapezius transfer.

Contralateral lower trapezius transfer for restoration of shoulder external rotation in traumatic brachial plexus palsy: a preliminary report and literature review

2013 ◽  
Vol 39 (8) ◽  
pp. 861-867 ◽  
Author(s):  
N. G. Satbhai ◽  
K. Doi ◽  
Y. Hattori ◽  
S. Sakamoto
Keyword(s):  
Brachial Plexus ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Donor Site ◽  
Nerve Transfer ◽  
Shoulder Function ◽  
No Donor ◽  
Nerve Transfers ◽  
Shoulder External Rotation ◽  
Lower Trapezius

The importance of external rotation of the shoulder is well accepted. Patients with inadequate recovery of shoulder function after nerve transfers for a brachial plexus injury have difficulty in using their reconstructed limb. The options for secondary procedures to improve shoulder function are often limited, especially if the spinal accessory nerve has been used earlier for nerve transfer or as a donor nerve for a free functioning muscle transfer. We have used the contralateral lower trapezius transfer to the infraspinatus in three cases, to restore shoulder external rotation. All patients had significant improvement in shoulder external rotation (mean 97°; range 80°–110°) and improved disability of the arm, shoulder and hand scores. The rotation occurred mainly at the glenohumeral joint, and was independent of the donor side. All patients were greatly satisfied with the outcome. Contralateral lower trapezius transfer appears to help in overall improvement of shoulder function by stabilizing the scapula. The results have remained stable after mean follow-up of 58 months (range 12–86). No donor site deficit was seen in any patient.

TRANSFER OF A FASCICLE FROM THE POSTERIOR CORD TO THE SUPRASCAPULAR NERVE AFTER INJURY OF THE UPPER ROOTS OF THE BRACHIAL PLEXUS

Neurosurgery ◽  
2009 ◽  
Vol 65 (4) ◽  
pp. E823-E825 ◽  
Author(s):  
Roberto Sergio Martins ◽  
Mario Gilberto Siqueira ◽  
Carlos Otto Heise ◽  
Manoel Jacobsen Teixeira
Keyword(s):  
Brachial Plexus ◽  
External Rotation ◽  
Trapezius Muscle ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Brachial Plexopathy ◽  
Nerve Reconstruction ◽  
Triceps Muscle ◽  
Isolated Injury

Abstract OBJECTIVE A new nerve transfer technique using a healthy fascicle of the posterior cord for suprascapular nerve reconstruction is presented. This technique was used in a patient with posttraumatic brachial plexopathy resulting in upper trunk injury with proximal root stumps that were unavailable for grafting associated with multiple nerve dysfunction. CLINICAL PRESENTATION A 45-year-old man sustained a right brachial plexus injury after a bicycle accident. Clinical evaluation and electromyography indicated upper trunk involvement. Trapezius muscle function and triceps strength were normal on physical examination. INTERVENTION The patient underwent a combined supra- and infraclavicular approach to the brachial plexus. A neuroma-in-continuity of the upper trunk and fibrotic C5 and C6 roots were identified. Electrical stimulation of the phrenic and spinal accessory nerves produced no response. The suprascapular nerve was dissected from the upper trunk, transected, and rerouted to the infraclavicular fossa. A healthy fascicle of the posterior cord to the triceps muscle was transferred to the suprascapular nerve. At the time of the 1-year follow-up evaluation, arm abduction against gravity and external rotation reached 40 and 34 degrees, respectively. CONCLUSION The posterior cord can be used as a source of donor fascicle to the suprascapular nerve after its infraclavicular relocation. This new intraplexal nerve transfer could be applied in patients with isolated injury of the upper trunk and concomitant lesion of the extraplexal nerve donors usually used for reinnervation of the suprascapular nerve.

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