Outcomes with suprascapular nerve reconstruction in obstetrical brachial plexus patients.
BACKGROUND
Restoration of shoulder abduction is very important following obstetrical brachial plexus paralysis. The purpose of this report is to present the authors' experience of suprascapular nerve reconstruction in 53 cases of obstetrical brachial plexus palsy.


METHODS
From 1978 to 2002, 170 children with obstetrical brachial plexus palsy were seen at the authors' institution. One hundred nine children underwent surgical treatment, and 53 of them had suprascapular nerve reconstruction.


RESULTS
The overall results were good or excellent in 96 percent of patients for the supraspinatus muscle and 75 percent for the infraspinatus muscle. The overall mean postoperative muscle grading was 3.71 +/- 0.7 for the supraspinatus muscle and 2.94 +/- 0.8 for the infraspinatus muscle (p < 0.05). By using the Mallet score, 23 patients (46 percent) achieved Mallet grade III and 24 patients (48 percent) achieved Mallet grade IV shoulder abduction function. Evaluating external rotation function, 21 patients (42 percent) achieved Mallet grade III and 20 patients (40 percent) achieved Mallet grade IV. Early surgery (<6 months) yielded significantly better results than late surgery (>6 months).


CONCLUSIONS
Suprascapular nerve neurotization is a worthwhile procedure and is a high priority in upper limb reanimation for restoration of glenohumeral joint stability, shoulder abduction, and external rotation. Concomitant neurotization of the axillary nerve yields improved outcomes in shoulder abduction function. The best results are seen in patients with high severity scores, when only the upper two roots are involved, and when direct neurotization of the suprascapular nerve is performed within 6 months after the injury.
Terzis
Julia K
JK
Norfolk, Va. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School and International Institute of Reconstructive Microsurgery.
Kostas
Ioannis
I
D001720:Birth Injuries / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome