Original ArticleNo Access

Outcomes of Spinal Accessory Nerve and Intercostal Nerve Transfers for Shoulder Stabilisation and Elbow Extension in Patients with C_5,6,7 Root Avulsion Injury

Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin General Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand

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Somsak LEECHAVENGVONGS

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Chairoj UERPAIROJKIT

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Navapong ANANTAVORASAKUL

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Piyabuth KITTITHAMVONGS

E-mail Address: piyabuthortho@gmail.com

Correspondence to: Piyabuth Kittithamvongs, Department of Orthopaedic Surgery, Institute of Orthopaedics, College of Medicine, Rangsit University Upper Extremity and Reconstructive Microsurgery Unit, Lerdsin General Hospital, 190 Silom Road, Bangkok 10500, Thailand, Tel: +66 3539800.

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, and

Worawit DENSIRI-AKSORN

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https://doi.org/10.1142/S2424835522500540Cited by:0 (Source: Crossref)

Abstract

Background: Upper arm type brachial plexus palsy results in decreased shoulder and elbow function. Reanimation of shoulder and elbow function is beneficial in these patients. The aim of this study is to report the results of restoring the shoulder abduction and elbow extension in patients with C_5,6,7 root avulsion injury by simultaneous transfer of the spinal accessory nerve for the supraspinatus muscle combined with the transferring of the sixth and seventh intercostal nerves for the serratus anterior muscle along with the third to fifth intercostal nerves to the triceps muscle.

Methods: All patients who underwent the above set of nerve transfers and had at least 2 years of follow-up were included in the study. The outcome measures included the Medical Research Council (MRC) grading of motor strength of shoulder abduction and elbow extension and range of motion of shoulder abduction and shoulder external rotation.

Results: The study included 10 patients with an average age of 27. The mean time from injury to surgery was 6 months and the mean follow-up period was 35 months. M4 grade shoulder abduction was restored in five patients, M3 grade in three patients and M2 grade in two. M4 grade elbow extension was achieved in four patients, M3 grade in four patients and M2 grade in two patients. The average arc of shoulder abduction and external rotation was 71° and −21°, respectively.

Conclusions: The spinal accessory nerve and the sixth and seventh intercostal nerves transfer to the supraspinatus muscle and serratus anterior muscle with the third to fifth intercostal nerves transfer to the triceps muscle provided satisfactory results for both shoulder abduction and elbow extension in C_5,6,7 root avulsion injury.

Level of Evidence: Level IV (Therapeutic)

Keywords:

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