Restoration of shoulder abduction in brachial plexus avulsion injuries with double neurotization from the spinal accessory nerve: a report of 13 cases

2016 ◽  
Vol 42 (7) ◽  
pp. 700-705 ◽  
Author(s):  
K. W. S. J. Huan ◽  
J. S. W. Tan ◽  
S. H. Tan ◽  
L. C. Teoh ◽  
F. C. Yong
Keyword(s):  
Brachial Plexus ◽  
Suprascapular Nerve ◽  
Axillary Nerve ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Shoulder Abduction ◽  
Root Avulsion ◽  
Level Of Evidence ◽  
Spinal Accessory ◽  
Single Donor

In upper (C5-C7) and total (C5-T1) root avulsion brachial plexus injury, a method of double neurotization from a single donor spinal accessory nerve to two target nerves (suprascapular nerve and axillary nerve) may be done, leaving donor nerves available for reconstruction procedures to restore other aspects of upper limb function. A mean range of shoulder abduction of 91° (SD 25°) was achieved through this procedure in our study of 13 cases, of which seven cases were C5-C7 root avulsion and six cases were C5-T1 root avulsion brachial plexus injuries. Six of the former group and three of the latter group achieved >90° shoulder abduction. The technique of double neurotization from a single donor nerve provides favourable results in restoring shoulder abduction in avulsion brachial plexus injuries. Level of evidence: IV

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.

Distal transfers as a primary treatment in obstetric brachial plexus palsy: a series of 20 cases

2016 ◽  
Vol 41 (8) ◽  
pp. 875-881 ◽  
Author(s):  
B. A. Ghanghurde ◽  
R. Mehta ◽  
K. M. Ladkat ◽  
B. B. Raut ◽  
M. R. Thatte
Keyword(s):  
Brachial Plexus ◽  
Elbow Flexion ◽  
Suprascapular Nerve ◽  
Primary Treatment ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Type I ◽  
Spinal Accessory ◽  
Obstetric Brachial Plexus

The purpose of this study was to examine the results of spinal accessory nerve to suprascapular nerve (with or without axillary nerve neurotization) and an Oberlin transfer as primary treatment in children with Narakas type I obstetric brachial plexus injuries, when parents refused to consent to conventional nerve trunk-/root-level reconstruction. A total of 20 children with poor shoulder abduction and no biceps antigravity function but with good hand function were treated with spinal accessory nerve to suprascapular nerve and an Oberlin transfer at a mean age of 5.8 months (SD 3.27; range 3–12.) All the patients were evaluated at a mean of 2.8 years (SD 0.8; range 1.5 to 3.8) post-operatively. Three patients were lost to follow-up. Of the remainder, 11 had grade 4+ power of elbow flexion and six patients had grade 4 power at 1 year follow-up; all had 4+ power of elbow flexion at final follow-up. At final follow-up the Mallet score was a mean of 15; (SD 4.22, range 9 to 20). Primary distal nerve transfers can give good outcomes in patients with obstetric brachial plexus injuries and may be an alternative to surgery on the nerve trunks Level of evidence: IV

Evaluation of infraspinatus reinnervation and function following spinal accessory nerve to suprascapular nerve transfer in adult traumatic brachial plexus injuries

Microsurgery ◽  
2016 ◽  
Vol 37 (5) ◽  
pp. 365-370 ◽  
Author(s):  
Heather L. Baltzer ◽  
Eric R. Wagner ◽  
Michelle F. Kircher ◽  
Robert J. Spinner ◽  
Allen T. Bishop ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Spinal Accessory ◽  
And Function
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