title: Shoulder abduction and external rotation restoration with nerve transfer.
abstract: BACKGROUND
  In upper brachial plexus palsy patients, loss of shoulder function and elbow flexion is obvious as the result of paralysed muscles innervated by the suprascapular, axillary and musculocutaneus nerve. Shoulder stabilisation, restoration of abduction and external rotation are important as more distal functions will be affected by the shoulder situation.
  
  
  METHODS
  Between 2005 and 2011, eleven patients with upper type brachial plexus palsy were operated on with triceps nerve branch transfer to anterior axillary nerve branch and spinal accessory nerve transfer to the suprascapular nerve for shoulder abduction and external rotation restoration. Nine patients met the inclusion criteria for the study. All patients were men with ages ranged from 21 to 35 years (average, 27.4 years). The interval between injury and surgery ranged from 4 to 11 months (average, 7.2 months). Atrophy of the supraspinatus, infraspinatus and deltoid muscle and subluxation at the glenohumeral joint was obvious in all patients preoperatively. During the pre-op examination all patients had at least muscle grading 4 on the triceps muscle.
  
  
  RESULTS
  The mean post-operative value of shoulder abduction was 112.2° (range: 60-170°) while preoperatively none of the patients was able for abduction (p<0.001). The mean post-operative value of shoulder external rotation was 66° (range: 35-110°) while preoperatively none of them was able for external rotation (p<0.001). Postoperative values of shoulder abduction were significantly better that those of external rotation (p=0.0004). The postoperative average muscle grading for shoulder abduction according the MRC scale was 3.6±0.5 and for the shoulder external rotation was 3.2±0.4.
  
  
  CONCLUSIONS
  Combined nerve transfer by using the spinal accessory nerve for suprascapular nerve neurotisation and one of the triceps nerve branches for axillary nerve and teres minor branch neurotisation is an excellent choice for shoulder abduction and external rotation restoration.
authors: Orthopaedic Department, University Hospital of Ioannina, Greece. Electronic address: ioanniskostas@hotmail.com.
authors: Ioannis
authors: I
authors: Kostas-Agnantis
authors: Orthopaedic Department, University Hospital of Ioannina, Greece.
authors: Anastasios
authors: A
authors: Korompilias
authors: Orthopaedic Department, University Hospital of Ioannina, Greece.
authors: Marios
authors: M
authors: Vekris
authors: Orthopaedic Department, University Hospital of Ioannina, Greece.
authors: Marios
authors: M
authors: Lykissas
authors: Orthopaedic Department, University Hospital of Ioannina, Greece.
authors: Ioannis
authors: I
authors: Gkiatas
authors: Orthopaedic Department, University Hospital of Ioannina, Greece.
authors: Gregory
authors: G
authors: Mitsionis
authors: Orthopaedic Department, University Hospital of Ioannina, Greece.
authors: Alexander
authors: A
authors: Beris
mesh_terms: D000328:Adult; D001365:Axilla / Q000294:innervation / Q000601:surgery; D001917:Brachial Plexus / Q000293:injuries / Q000503:physiopathology* / Q000601:surgery; D020516:Brachial Plexus Neuropathies / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D016067:Nerve Transfer; D059348:Peripheral Nerve Injuries / Q000503:physiopathology* / Q000601:surgery; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D020127:Recovery of Function; D017006:Rotator Cuff / Q000294:innervation / Q000601:surgery; D012540:Scapula / Q000294:innervation / Q000601:surgery; D012782:Shoulder / Q000294:innervation* / Q000601:surgery; D016896:Treatment Outcome