Nerve Transfers for Shoulder Function for Traumatic Brachial Plexus Injuries

Abstract

The objective of this article was to evaluate the clinical results of nerve transfer procedures for the restoration of shoulder abduction and external rotation in patients with traumatic brachial plexus injuries. A retrospective study was done to determine the results of nerve transfers for shoulder function in patients with traumatic brachial plexus injuries. The authors evaluated shoulder abduction and external rotation in terms of type of nerve transfer performed (single vs. double) and the time delay to surgery (greater or less than 6 mo). A total of 20 patients were evaluated with 5 patients having double nerve transfers and 15 patients having single nerve transfers to restore shoulder function. All surgeries were done within 12 months of injury. The average follow-up for the 20 patients was 28.4 ± 17.5 months (minimum of 12 mo follow-up for all patients). The mean shoulder abduction and external rotation for the single nerve transfer group was 71.3 ± 48 degrees and 56 ± 44 degrees, respectively. For the double nerve transfer group, the mean shoulder abduction and external rotation was 123 ± 49 degrees and 86 ± 35 degrees, respectively. The difference was significant for the shoulder abduction (p = 0.05) but not for the external rotation (p = 0.19). In terms of time delay to surgery, there was no difference between surgery done in 6 months or less versus those done greater than 6 months but less than 12 months for shoulder abduction (88.1 ± 47.7 degrees and 77.1 ± 63.4 degrees, respectively, p = 0.67) and shoulder external rotation (63.8 ± 42.2 degrees and 62.8 ± 49.3 degrees, respectively, p = 0.96). The results of this study showed that nerve transfers can restore functional shoulder abduction and external rotation. Double nerve transfers tend to have significantly greater range of shoulder abduction compared with single nerve transfers if done within 1 year of injury.

Keywords

brachial plexus - shoulder function - nerve transfer

• References

• 1 Terzis JK, Kostopoulos VK. The surgical treatment of brachial plexus injuries in adults. Plast Reconstr Surg 2007; 119 (4) 73e-92e
• 2 Doi K, Hattori Y, Ikeda K, Dhawan V. Significance of shoulder function in the reconstruction of prehension with double free-muscle transfer after complete paralysis of the brachial plexus. Plast Reconstr Surg 2003; 112 (6) 1596-1603
• 3 Richards RR, Waddell JP, Hudson AR. Shoulder arthrodesis for the treatment of brachial plexus palsy. Clin Orthop Relat Res 1985; 198 (198) 250-258
• 4 Rouholamin E, Wootton JR, Jamieson AM. Arthrodesis of the shoulder following brachial plexus injury. Injury 1991; 22 (4) 271-274
• 5 Malessy MJ, de Ruiter GC, de Boer KS, Thomeer RT. Evaluation of suprascapular nerve neurotization after nerve graft or transfer in the treatment of brachial plexus traction lesions. J Neurosurg 2004; 101 (3) 377-389
• 6 Yamada S, Lonser RR, Colohan AR, Yamada SM, Won DJ. Bypass coaptation for cervical root avulsion: indications for optimal outcome. Neurosurgery 2009; 65 (4, Suppl) A203-A211
• 7 Yamada S, Lonser RR, Iacono RP, Morenski JD, Bailey L. Bypass coaptation procedures for cervical nerve root avulsion. Neurosurgery 1996; 38 (6) 1145-1151 , discussion 1151–1152
• 8 Weber RV, Mackinnon SE. Upper extremity nerve transfers. In: Slutsky DJ, Hentz VR, , eds. Peripheral Nerve Surgery: Practical Applications in the Upper Extremity. Philadelphia: Churchill Livingstone; 2006: 89-108
• 9 Mackinnon SE, Colbert SH. Nerve transfers in the hand and upper extremity surgery. Tech Hand Up Extrem Surg 2008; 12 (1) 20-33
• 10 Garg R, Merrell GA, Hillstrom HJ, Wolfe SW. Comparison of nerve transfers and nerve grafting for traumatic upper plexus palsy: a systematic review and analysis. J Bone Joint Surg Am 2011; 93 (9) 819-829
• 11 Malessy MJ, van Duinen SG, Feirabend HK, Thomeer RT. Correlation between histopathological findings in C-5 and C-6 nerve stumps and motor recovery following nerve grafting for repair of brachial plexus injury. J Neurosurg 1999; 91 (4) 636-644
• 12 Sedel L. The results of surgical repair of brachial plexus injuries. J Bone Joint Surg Br 1982; 64 (1) 54-66
• 13 Yang LJS, Chang KWC, Chung KC. A systematic review of nerve transfer and nerve repair for the treatment of adult upper brachial plexus injury. Neurosurgery 2012; 71 (2) 417-429 , discussion 429
• 14 Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P. Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases. J Hand Surg Am 2003; 28 (4) 633-638
• 15 Cardenas-Mejia A, O'Boyle CP, Chen KT, Chuang DCC. Evaluation of single-, double-, and triple-nerve transfers for shoulder abduction in 90 patients with supraclavicular brachial plexus injury. Plast Reconstr Surg 2008; 122 (5) 1470-1478
• 16 Sammer DM, Kircher MF, Bishop AT, Spinner RJ, Shin AY. Hemi-contralateral C7 transfer in traumatic brachial plexus injuries: outcomes and complications. J Bone Joint Surg Am 2012; 94 (2) 131-137
• 17 Waikakul S, Orapin S, Vanadurongwan V. Clinical results of contralateral C7 root neurotization to the median nerve in brachial plexus injuries with total root avulsions. J Hand Surg [Br] 1999; 24 (5) 556-560
• 18 Chuang DC, Hernon C. Minimum 4-year follow-up on contralateral C7 nerve transfers for brachial plexus injuries. J Hand Surg Am 2012; 37 (2) 270-276
• 19 Zhang CG, Gu YD. Contralateral C7 nerve transfer - Our experiences over past 25 years. J Brachial Plex Peripher Nerve Inj 2011; 6 (1) 10
• 20 Hattori Y, Doi K, Fukushima S, Kaneko K. The diagnostic value of intraoperative measurement of choline acetyltransferase activity during brachial plexus surgery. J Hand Surg [Br] 2000; 25 (5) 509-511
• 21 Oberle J, Antoniadis G, Kast E, Richter HP. Evaluation of traumatic cervical nerve root injuries by intraoperative evoked potentials. Neurosurgery 2002; 51 (5) 1182-1188 , discussion 1188–1190
• 22 Suzuki K, Doi K, Hattori Y, Pagsaligan JM. Long-term results of spinal accessory nerve transfer to the suprascapular nerve in upper-type paralysis of brachial plexus injury. J Reconstr Microsurg 2007; 23 (6) 295-299
• 23 Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P, Malungpaishrope K. Combined nerve transfers for C5 and C6 brachial plexus avulsion injury. J Hand Surg Am 2006; 31 (2) 183-189
• 24 Bertelli JA, Ghizoni MF. Reconstruction of C5 and C6 brachial plexus avulsion injury by multiple nerve transfers: spinal accessory to suprascapular, ulnar fascicles to biceps branch, and triceps long or lateral head branch to axillary nerve. J Hand Surg Am 2004; 29 (1) 131-139
• 25 Terzis JK, Kostas I. Suprascapular nerve reconstruction in 118 cases of adult posttraumatic brachial plexus. Plast Reconstr Surg 2006; 117 (2) 613-629