Two-level motor nerve transfer for the treatment of long thoracic nerve palsy

2011 ◽  
Vol 115 (4) ◽  
pp. 858-864 ◽  
Author(s):  
Wilson Z. Ray ◽  
Mitchell A. Pet ◽  
Michael C. Nicoson ◽  
Andrew Yee ◽  
Lorna C. Kahn ◽  
...  
Keyword(s):  
Motor Nerve ◽  
Nerve Transfer ◽  
Shoulder Function ◽  
Favorable Result ◽  
Long Thoracic Nerve ◽  
Therapy Regimen ◽  
Thoracic Nerve ◽  
Nerve Transfers ◽  
Postoperative Physical Therapy ◽  
Thoracodorsal Nerve

The authors report a case of long thoracic nerve (LTN) palsy treated with two-level motor nerve transfers of a pectoral fascicle of the middle trunk, and a branch of the thoracodorsal nerve. This procedure resulted in near-total improvement of the winged scapula deformity, and a return of excellent shoulder function. A detailed account of the postoperative physical therapy regimen is included, as this critical component of the favorable result cannot be overlooked. This case establishes the two-level motor nerve transfer as a new option for treating LTN palsy, and demonstrates that nerve transfers should be considered in the therapeutic algorithm of an idiopathic mononeuritis.

Results of Distal Nerve Transfers in Restoration of Shoulder Function in C5 and C6 Root Avulsion Injury to the Brachial Plexus

2017 ◽  
Vol 14 (01) ◽  
pp. 021-025
Author(s):  
Prem Bhandari
Keyword(s):  
Brachial Plexus ◽  
External Rotation ◽  
Nerve Transfer ◽  
Shoulder Function ◽  
Shoulder Abduction ◽  
Root Avulsion ◽  
Long Thoracic Nerve ◽  
Avulsion Injury ◽  
Nerve Transfers ◽  
Distal Nerve

Background The lack of shoulder function following brachial plexus injury is a debilitating condition. Nerve root avulsion injury precludes a direct nerve repair. Under these circumstances, distal nerve transfer is a well-established technique in the restoration of shoulder abduction and external rotation. Methods Thirty patients with C5 and C6 root avulsion injury were treated with distal nerve transfers in the period between February 2009 and December 2012.The average denervation period was 5.6 months. Shoulder function was restored by posterior transfer of distal part of the spinal accessory nerve into the suprascapular nerve and transfer of the long head triceps branch of radial nerve to the anterior branch of axillary nerve. An additional nerve transfer was performed in four patients with winged scapula by transferring a part of thoracodorsal nerve into the long thoracic nerve. Results Twenty-seven patients recovered shoulder abduction; 18 scored M4 and 9 scored M3. Range of abduction averaged 118 degrees (range, 90–170 degrees). Nineteen patients restored external rotation with an average of 53 degrees (range: 30–70 degrees). Three patients failed to recover shoulder abduction though the joint regained stability. External rotation remained severely restricted in 11 patients. At final follow-up, winging of scapula improved in three of four patients following reinnervation of the serratus anterior muscle. Conclusion Nerve transfers, when performed close to the target muscles, restore good range and strength of shoulder abduction in most patients with C5 and C6 root avulsion injuries. However, return in external rotation is not as good as the recovery in abduction.

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.

Long Thoracic Nerve Transfer for Children With Brachial Plexus Injuries

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Chase Kluemper ◽  
Mike Aversano ◽  
Scott Kozin ◽  
Dan A. Zlotolow
Keyword(s):  
Brachial Plexus ◽  
Nerve Transfer ◽  
Long Thoracic Nerve ◽  
Thoracic Nerve

Anterior Interosseous–to–Ulnar Motor Nerve Transfers: A Single Center’s Experience in Restoring Intrinsic Hand Function

Hand ◽  
2020 ◽  
pp. 155894472092848
Author(s):  
Graham J. McLeod ◽  
Blair R. Peters ◽  
Tanis Quaife ◽  
Tod A. Clark ◽  
Jennifer L. Giuffre
Keyword(s):  
Outcome Measures ◽  
Motor Nerve ◽  
Hand Function ◽  
Donor Site ◽  
Nerve Transfer ◽  
Secondary Outcome ◽  
No Donor ◽  
Motor Branch ◽  
Nerve Transfers

Background: Transfer of the anterior interosseous nerve (AIN) into the ulnar motor branch improves intrinsic hand function in patients with high ulnar nerve injuries. We report our outcomes of this nerve transfer and hypothesize that any improvement in intrinsic hand function is beneficial to patients. Methods: A retrospective review of all AIN-to-ulnar motor nerve transfers, including both supercharged end-to-side (SETS) and end-to-end (ETE) transfers, from 2011 to 2018 performed by 2 surgeons was conducted. All adult patients who underwent this nerve transfer for any reason with greater than 6 months’ follow-up and completed charts were included. Primary outcome measures were motor function using the British Medical Research Council (BMRC) grading system and subjective satisfaction with surgery using a visual analog scale. Secondary outcome measures included complications and donor site deficits. Results: Of the 57 patients who underwent nerve transfer, 32 patients met the inclusion criteria. The average follow-up and average time to surgery were 12 and 15.6 months, respectively. The overall average BMRC score was 2.9/5, with a trend toward better recovery in patients who received earlier surgery (<12 months = BMRC 3.7, ≥12 months = BMRC 2.2; P < .01). Patients with an SETS transfer had better results that those with an ETE transfer (SETS = 3.2, ETE = 2.6). There were no donor deficits after operation. One patient developed complex regional pain syndrome. Conclusions: Patients with earlier surgery and an in-continuity nerve (receiving an SETS transfer) showed improved recovery with a higher BMRC grade compared with those who underwent later surgery. Any improvements in intrinsic hand function would be beneficial to patients.

Long Thoracic Nerve Neurotization for Restoration of Shoulder Function in C5-7 Brachial Plexus Preganglionic Injuries: Case Report

2010 ◽  
Vol 35 (9) ◽  
pp. 1427-1431 ◽  
Author(s):  
Tetsuya Yamada ◽  
Kazuteru Doi ◽  
Yasunori Hattori ◽  
Shushi Hoshino ◽  
Soutetsu Sakamoto ◽  
...  
Keyword(s):  
Case Report ◽  
Brachial Plexus ◽  
Shoulder Function ◽  
Long Thoracic Nerve ◽  
Thoracic Nerve

Nerve transfers in the upper extremity following cervical spinal cord injury. Part 1: Systematic review of the literature

2019 ◽  
Vol 31 (5) ◽  
pp. 629-640 ◽  
Author(s):  
Jawad M. Khalifeh ◽  
Christopher F. Dibble ◽  
Anna Van Voorhis ◽  
Michelle Doering ◽  
Martin I. Boyer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Upper Extremity ◽  
Cervical Spinal Cord ◽  
Motor Nerve ◽  
Nerve Transfer ◽  
Elbow Extension ◽  
Nerve Transfers ◽  
Finger Extension ◽  
Cord Injury ◽  
Upper Extremity Function

OBJECTIVEPatients with cervical spinal cord injury (SCI)/tetraplegia consistently rank restoring arm and hand function as their top functional priority to improve quality of life. Motor nerve transfers traditionally used to treat peripheral nerve injuries are increasingly being used to treat patients with cervical SCIs. In this study, the authors performed a systematic review summarizing the published literature on nerve transfers to restore upper-extremity function in tetraplegia.METHODSA systematic literature search was conducted using Ovid MEDLINE 1946–, Embase 1947–, Scopus 1960–, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and clinicaltrials.gov to identify relevant literature published through January 2019. The authors included studies that provided original patient-level data and extracted information on clinical characteristics, operative details, and strength outcomes after nerve transfer procedures. Critical review and synthesis of the articles were performed.RESULTSTwenty-two unique studies, reporting on 158 nerve transfers in 118 upper limbs of 92 patients (87 males, 94.6%) were included in the systematic review. The mean duration from SCI to nerve transfer surgery was 18.7 months (range 4 months–13 years) and mean postoperative follow-up duration was 19.5 months (range 1 month–4 years). The main goals of reinnervation were the restoration of thumb and finger flexion, elbow extension, and wrist and finger extension. Significant heterogeneity in transfer strategy and postoperative outcomes were noted among the reports. All but one case report demonstrated recovery of at least Medical Research Council grade 3/5 strength in recipient muscle groups; however, there was greater variation in the results of larger case series. The best, most consistent outcomes were demonstrated for restoration of wrist/finger extension and elbow extension.CONCLUSIONSMotor nerve transfers are a promising treatment option to restore upper-extremity function after SCI. Flexor reinnervation strategies show variable treatment effect sizes; however, extensor reinnervation may provide more consistent, meaningful recovery. Despite numerous published case reports describing good patient outcomes with nerve transfers, there remains a paucity in the literature regarding optimal timing and long-term clinical outcomes with these procedures.

Supercharged End-to-Side Anterior Interosseous to Ulnar Motor Nerve Transfer for Hirayama Disease: A Case Report

Hand ◽  
2021 ◽  
pp. 155894472110635
Author(s):  
Aleixo Abreu Tanure ◽  
Luis Guilherme Rosifini Alves Rezende ◽  
Ana Carolina Pazim ◽  
Marcel Leal Ribeiro
Keyword(s):  
Case Report ◽  
Ulnar Nerve ◽  
Motor Nerve ◽  
Hand Function ◽  
Rare Condition ◽  
Nerve Transfer ◽  
Late Presentation ◽  
Hirayama Disease ◽  
Nerve Transfers ◽  
First Case

Hirayama disease is a rare condition of cervical myelopathy. Its early identification and correction can optimize functional outcomes. However, late presentation and some more severe cases may be associated with loss of hand function. Among the cases described, there are no reports of nerve transfers for this condition. We presented the first case report of a Hirayama disease of isolated ulnar nerve impairment managed with nerve transfer. Electroneuromyography showed isolated preganglionic involvement of C7, C8, and T1, with no sensory changes. The patient underwent nerve transfer with anterior interosseous nerve to ulnar nerve supercharge end-to-side, recovering hand function in 7 months.

scholarly journals Surgical and Clinical Decision Making in Isolated Long Thoracic Nerve Palsy

Hand ◽  
2017 ◽  
Vol 13 (6) ◽  
pp. 689-694 ◽  
Author(s):  
Shelley S. Noland ◽  
Emily M. Krauss ◽  
John M. Felder ◽  
Susan E. Mackinnon
Keyword(s):  
Decision Making ◽  
Nerve Stimulation ◽  
Nerve Palsy ◽  
Clinical Decision Making ◽  
Treatment Algorithm ◽  
Nerve Transfer ◽  
Clinical Decision ◽  
Serratus Anterior ◽  
Long Thoracic Nerve ◽  
Thoracic Nerve

Background: Isolated long thoracic nerve palsy results in scapular winging and destabilization. In this study, we review the surgical management of isolated long thoracic nerve palsy and suggest a surgical technique and treatment algorithm to simplify management. Methods: In total, 19 patients who required surgery for an isolated long thoracic nerve palsy were reviewed retrospectively. Preoperative demographics, electromyography (EMG), and physical examinations were reviewed. Intraoperative nerve stimulation, surgical decision making, and postoperative outcomes were reviewed. Results: In total, 19 patients with an average age of 32 were included in the study. All patients had an isolated long thoracic nerve palsy caused by either an injury (58%), Parsonage-Turner syndrome (32%), or shoulder surgery (10%); 18 patients (95%) underwent preoperative EMG; 10 with evidence of denervation (56%); and 13 patients had motor unit potentials in the serratus anterior (72%). The preoperative EMG did not correlate with intraoperative nerve stimulation in 13 patients (72%) and did correlate in 5 patients (28%); 3 patients had a nerve transfer (3 thoracodorsal to long thoracic at lateral chest, 1 pec to long thoracic at supraclavicular incision). In the 3 patients who had a nerve transfer, there was return of full forward flexion of the shoulder at an average of 2.5 months. Conclusions: A treatment algorithm based on intraoperative nerve stimulation will help guide surgeons in their clinical decision making in patients with isolated long thoracic nerve palsy. Intraoperative nerve stimulation is the gold standard in the management of isolated long thoracic nerve palsy.

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