title: 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.
abstract: OBJECTIVE
  In C5 and C6 brachial plexus avulsion lesions, elbow flexion, shoulder abduction, and external rotation are the functions that need to be restored. Because the proximal stumps are not available for grafting, surgical repair is based on nerve transfers. The purpose of this study was to describe and report the results of the use of multiple nerve transfers in the reconstruction of these avulsion injuries.
  
  
  METHODS
  Ten patients had multiple nerve transfers: cranial nerve XI to the suprascapular nerve, ulnar nerve fascicles to the biceps motor branch, and triceps long or lateral head motor branch to the axillary nerve. Triceps branch transfer was performed through a posterior arm incision.
  
  
  RESULTS
  Two years after surgery, all the patients had recovered full elbow flexion; 7 scored M4 and 3 scored M3+ according to Medical Research Council scoring. All the patients had recovered active abduction and external rotation. Abduction recovery averaged 92 degrees (range, 65 degrees-120 degrees) and external rotation, measured from full internal rotation, averaged 93 degrees (range, 80 degrees-120 degrees). Shoulder abduction strength was graded M4 in 3 patients and M3 in the remaining 7 patients. Shoulder external rotation strength was graded M4 in 2 patients, M3 in 5 patients, and M2 in 3 patients. No donor site deficits were observed.
  
  
  CONCLUSIONS
  The proposed nerve transfers constitute a valid strategy in C5-C6 avulsion injury reconstruction.
authors.affiliation: Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Praça Getulio Vargas 322, Florianópolis, Santa Catarina 88020030, Brazil.
authors.forename: Jayme Augusto
authors.initials: JA
authors.lastname: Bertelli
authors.forename: Marcos Flávio
authors.initials: MF
authors.lastname: Ghizoni
mesh_terms: D000055:Accessory Nerve / Q000601:surgery; D000328:Adult; D001132:Arm / Q000294:innervation; D001365:Axilla / Q000294:innervation; D001917:Brachial Plexus / Q000293:injuries* / Q000601:surgery*; D004551:Elbow Joint / Q000503:physiopathology; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000294:innervation; D016067:Nerve Transfer / Q000379:methods*; D016059:Range of Motion, Articular / Q000502:physiology; D012399:Rotation; D012540:Scapula / Q000294:innervation; D012785:Shoulder Joint / Q000503:physiopathology; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000601:surgery