title: Radial to axillary nerve neurotization for brachial plexus injury in children: a combined case series.
abstract: OBJECTIVE
  Axillary nerve palsy, isolated or as part of a more complex brachial plexus injury, can have profound effects on upper-extremity function. Radial to axillary nerve neurotization is a useful technique for regaining shoulder abduction with little compromise of other neurological function. A combined experience of this procedure used in children is reviewed.
  
  
  METHODS
  A retrospective review of the authors' experience across 3 tertiary care centers with brachial plexus and peripheral nerve injury in children (younger than 18 years) revealed 7 cases involving patients with axillary nerve injury as part of an overall brachial plexus injury with persistent shoulder abduction deficits. Two surgical approaches to the region were used.
  
  
  RESULTS
  Four infants (ages 0.6, 0.8, 0.8, and 0.6 years) and 3 older children (ages 8, 15, and 17 years) underwent surgical intervention. No patient had significant shoulder abduction past 15° preoperatively. In 3 cases, additional neurotization was performed in conjunction with the procedure of interest. Two surgical approaches were used: posterior and transaxillary. All patients displayed improvement in shoulder abduction. All were able to activate their deltoid muscle to raise their arm against gravity and 4 of 7 were able to abduct against resistance. The median duration of follow-up was 15 months (range 8 months to 5.9 years).
  
  
  CONCLUSIONS
  Radial to axillary nerve neurotization improved shoulder abduction in this series of patients treated at 3 institutions. While rarely used in children, this neurotization procedure is an excellent option to restore deltoid function in children with brachial plexus injury due to birth or accidental trauma.
authors.affiliation: Departments of Neurological Surgery and.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zuckerman
authors.forename: Ilyas M
authors.initials: IM
authors.lastname: Eli
authors.forename: Manish N
authors.initials: MN
authors.lastname: Shah
authors.forename: Nadine
authors.initials: N
authors.lastname: Bradley
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Stutz
authors.forename: Tae Sung
authors.initials: TS
authors.lastname: Park
authors.forename: John C
authors.initials: JC
authors.lastname: Wellons
mesh_terms: D000293:Adolescent; D001917:Brachial Plexus / Q000293:injuries*; D020516:Brachial Plexus Neuropathies / Q000209:etiology / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016067:Nerve Transfer / Q000379:methods; D010243:Paralysis / Q000503:physiopathology; D059348:Peripheral Nerve Injuries / Q000150:complications; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000294:innervation* / Q000503:physiopathology
keywords: OBPP = obstetric brachial plexus palsy; axillary nerve injury; brachial plexus; neurotization; peripheral nerve