title: Nerve transfers for shoulder function for traumatic brachial plexus injuries.
abstract: The objective of this article was to evaluate the clinical results of nerve transfer procedures for the restoration of shoulder abduction and external rotation in patients with traumatic brachial plexus injuries. A retrospective study was done to determine the results of nerve transfers for shoulder function in patients with traumatic brachial plexus injuries. The authors evaluated shoulder abduction and external rotation in terms of type of nerve transfer performed (single vs. double) and the time delay to surgery (greater or less than 6 mo). A total of 20 patients were evaluated with 5 patients having double nerve transfers and 15 patients having single nerve transfers to restore shoulder function. All surgeries were done within 12 months of injury. The average follow-up for the 20 patients was 28.4 ± 17.5 months (minimum of 12 mo follow-up for all patients). The mean shoulder abduction and external rotation for the single nerve transfer group was 71.3 ± 48 degrees and 56 ± 44 degrees, respectively. For the double nerve transfer group, the mean shoulder abduction and external rotation was 123 ± 49 degrees and 86 ± 35 degrees, respectively. The difference was significant for the shoulder abduction (p = 0.05) but not for the external rotation (p = 0.19). In terms of time delay to surgery, there was no difference between surgery done in 6 months or less versus those done greater than 6 months but less than 12 months for shoulder abduction (88.1 ± 47.7 degrees and 77.1 ± 63.4 degrees, respectively, p = 0.67) and shoulder external rotation (63.8 ± 42.2 degrees and 62.8 ± 49.3 degrees, respectively, p = 0.96). The results of this study showed that nerve transfers can restore functional shoulder abduction and external rotation. Double nerve transfers tend to have significantly greater range of shoulder abduction compared with single nerve transfers if done within 1 year of injury.
authors.affiliation: Microsurgery Unit, Department of Orthopedics, Philippine General Hospital, University of the Philippines-Manila, College of Medicine, Manila, Philippines.
authors.forename: Emmanuel P
authors.initials: EP
authors.lastname: Estrella
authors.affiliation: Microsurgery Unit, Department of Orthopedics, Philippine General Hospital, University of the Philippines-Manila, College of Medicine, Manila, Philippines.
authors.forename: Arnaldo S
authors.initials: AS
authors.lastname: Favila
mesh_terms: D000293:Adolescent; D000328:Adult; D020516:Brachial Plexus Neuropathies / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation; D016067:Nerve Transfer / Q000379:methods; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012399:Rotation; D012785:Shoulder Joint / Q000503:physiopathology*; D016896:Treatment Outcome; D055815:Young Adult