Evaluation of suprascapular nerve neurotization after nerve graft or transfer in the treatment of brachial plexus traction lesions.
OBJECTIVE
The aim of this retrospective study was to evaluate the restoration of shoulder function by means of suprascapular nerve neurotization in adult patients with proximal C-5 and C-6 lesions due to a severe brachial plexus traction injury. The primary goal of brachial plexus reconstructive surgery was to restore biceps muscle function and, secondarily, to reanimate shoulder function.


METHODS
Suprascapular nerve neurotization was performed by grafting the C-5 nerve in 24 patients and by accessory or hypoglossal nerve transfer in 29 patients. Additional neurotization involving the axillary nerve was performed in 18 patients. Postoperative needle electromyography studies of the supraspinatus, infraspinatus, and deltoid muscles showed signs of reinnervation in most patients; however, active glenohumeral shoulder function recovery was poor. In nine (17%) of 53 patients supraspinatus muscle strength was Medical Research Council (MRC) Grade 3 or 4 and in four patients (8%) infraspinatus muscle power was MRC Grade 3 or 4. In 18 patients in whom deltoid muscle reinnervation was attempted, MRC Grade 3 or 4 function was demonstrated in two (11%). In the overall group, eight patients (15%) exhibited glenohumeral abduction with a mean of 44 +/- 17 degrees (standard deviation [SD]; median 45 degrees) and four patients (8%) exhibited glenohumeral exorotation with a mean of 48 +/- 24 degrees (SD; median 53 degrees). In only three patients (6%) were both functions regained.


CONCLUSIONS
The reanimation of shoulder function in patients with proximal C-5 and C-6 brachial plexus traction injuries following suprascapular nerve neurotization is disappointingly low.
Malessy
Martijn J A
MJ
Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands. M.J.A.Malessy@lumc.nl
de Ruiter
Godard C W
GC
de Boer
Kees S
KS
Thomeer
Ralph T W M
RT
D000293:Adolescent; D000328:Adult; D001132:Arm / Q000294:innervation*; D001917:Brachial Plexus / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D003288:Contusions / Q000503:physiopathology / Q000601:surgery*; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation*; D009416:Nerve Regeneration / Q000502:physiology; D016067:Nerve Transfer / Q000379:methods*; D010291:Paresis / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D012421:Rupture; D012782:Shoulder / Q000294:innervation*; D012785:Shoulder Joint / Q000294:innervation; D013126:Spinal Nerve Roots / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D013180:Sprains and Strains / Q000503:physiopathology / Q000601:surgery*