title: Simultaneous intercostal nerve transfers to deltoid and triceps muscle through the posterior approach.
abstract: OBJECTIVE
  This study reports the results of restoring the deltoid and triceps functions in patients with C5, C6, and C7 root avulsion injuries by simultaneously transferring 4 intercostal nerves to the anterior axillary nerve and the nerve to the long head of the triceps through the posterior approach.
  
  
  METHODS
  Nine patients with C5, C6, and C7 root avulsion injuries underwent spinal accessory nerve transfer to the suprascapular nerve combined with transfer of the third and fourth intercostal nerves to the anterior axillary nerve for shoulder reconstruction. Simultaneous transfer of the fifth and sixth intercostal nerves to the radial nerve branch of the triceps was done to restore elbow extension.
  
  
  RESULTS
  For shoulder function, 8 patients had M4 recovery and 1 patient had M2 recovery. Average shoulder abduction and external rotation were 69° and 42°, respectively. For elbow extension, 3 patients achieved M3 recovery, 5 patients had M2 recovery, and 1 patient had M1 recovery.
  
  
  CONCLUSIONS
  Reconstruction of 2 muscles with intercostal nerves is possible when both muscles act synergistically, such as shoulder abduction and elbow extension. Two intercostal nerves are adequate to transfer for deltoid reconstruction but not enough for elbow extension against gravity.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin General Hospital, Bangkok, Thailand. kanchai_hand@yahoo.com
authors.forename: Kanchai
authors.initials: K
authors.lastname: Malungpaishrope
authors.forename: Somsak
authors.initials: S
authors.lastname: Leechavengvongs
authors.forename: Kiat
authors.initials: K
authors.lastname: Witoonchart
authors.forename: Chairoj
authors.initials: C
authors.lastname: Uerpairojkit
authors.forename: Artit
authors.initials: A
authors.lastname: Boonyalapa
authors.forename: Disorn
authors.initials: D
authors.lastname: Janesaksrisakul
mesh_terms: D000328:Adult; D001917:Brachial Plexus / Q000293:injuries*; D057645:Deltoid Muscle / Q000601:surgery*; D004551:Elbow Joint / Q000503:physiopathology; D005260:Female; D006801:Humans; D007367:Intercostal Nerves / Q000637:transplantation*; D008297:Male; D016067:Nerve Transfer / Q000379:methods*; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012399:Rotation; D012782:Shoulder / Q000503:physiopathology