Outcome of Dual Nerve Transfer in C5-C6 Brachial Plexus Injuries.

Authors

  • Muhammad Ali Fellow Hand and Microsurgery National Orthopedics Hospital Bahawalpur
  • Tehseen Ahmad Cheema Chief Surgeon National Orthopedics Hospital, Bahawalpur 6Medical officer National Orthopedics Hospital Bahawalpur
  • Muhammad Khizer Hayat Makki Fellow Hand and Microsurgery National Orthopedics Hospital Bahawalpur
  • Hussan Birkhez Shami Fellow Hand and Microsurgery National Orthopedics Hospital Bahawalpur
  • Baqir Hussain Fellow Hand and Microsurgery National Orthopedics Hospital Bahawalpur
  • Hafiz Muhammad Ahmad Qureshi Medical officer National Orthopedics Hospital Bahawalpur

Keywords:

Axillary nerve, Brachial plexus, Nerve transfer, Spinal Accessary nerve, Suprascapular nerve.

Abstract

Objective: To determine the outcome of Spinal Accessary nerve to Suprascapular nerve and motor branch of Radial nerve transfer to the Axillary nerve for restoration of shoulder abduction and external rotation in patients with C5-C6 brachial plexus injury.

Methods: We conducted this descriptive study in National Orthopedics Hospital Bahawalpur. The study period extended from 12th June 2015 to 12th December 2020.All patients with C5-C6 injury fulfilling the inclusion criteria were operated with Spinal Accessary nerve to Suprascapular nerve and motor branch of Radial nerve transfer to the Axillary nerve. Post operative functional assessment was done by measuring shoulder abduction, external rotation and strength of abduction.

Results: The total number of patients in this study were 14. Male patients were 13(92.85% ) and female 1(7.14%).The mean age was 29.2±7 years. Right shoulder was affected in 9(64.28%) patients and left in 5(35.7%). The mean follow up period was 24.2±3.3 months. The shoulder abduction improved from pre operative 0 o to 97.8o±4o while external rotation from 0 o to 30 o± 5o postoperatively. The abduction muscle strength as per Medical Research Council (MRC) scale was M4 in 9(64.28%) and M3 in 3(21.42%) patients.

Conclusion: Satisfactory shoulder abduction with adequate muscle strength and external rotation was achieved in majority of our patients of C5-C6 brachial plexus injury treated with dual nerve transfer,This transfer  utilized Spinal Accessary nerve to Suprascapular nerve and motor branch of Radial nerve to the Axillary nerve.

References

Vekris MD, Beris AE, Pafilas D, Lykissas MG, Xenakis TA, Soucacos PN. Shoulder reanimation in posttraumatic brachial plexus paralysis. Injury 2010;41(3):231-238.

Bertelli JA, Ghizoni MF. Results of spinal accessory to suprascapular nerve transfer in 110 patients with complete palsy of the brachial plexus. J Spine Surg 2016 ;24(6):990-995.

Chu B, Wang H, Chen L, Gu Y, Hu S. Dual nerve transfers for restoration of shoulder function after brachial plexus avulsion injury. Ann Plast Surg 2016 ;76(6):668-673.

Aszmann OC, Dellon AL, Birely BT, McFarland EG. Innervation of the human shoulder joint and its implications for surgery. Clin Orthop Relat Res 1996;330:202-207.

Belviso I, Palermi S, Sacco AM, Romano V, Corrado B, Zappia M,et al. Brachial plexus injuries in sport medicine: Clinical evaluation, diagnostic approaches, treatment options, and rehabilitative interventions. J Funct Morphol Kinesiol 2020;5(2):22-27.

Lafosse T, Gerosa T, Serane J, Bouyer M, Masmejean EH, Le Hanneur M. Double-nerve transfer to the axillary nerve in traumatic upper trunk brachial plexus injuries using an axillary approach: anatomical description and preliminary case series.Oper Neurosurg (Hagerstown) 2020;19(2):131-139.

Hardcastle N, Texakalidis P, Nagarajan P, Tora MS, Boulis NM. Recovery of shoulder abduction in traumatic brachial plexus palsy: a systematic review and meta-analysis of nerve transfer versus nerve graft. Neurosurg Rev 2020;43(3):951-956.

Ramachandran S, Midha R. Recent advances in nerve repair. Neurol India 2019 ;67(7):106-114.

Lu J, Xu J, Xu W, Xu L, Fang Y, Chen L, et al. Combined nerve transfers for repair of the upper brachial plexus injuries through a posterior approach. Microsurgery 2012 ;32(2):111-117.

Estrella EP, Favila Jr AS. Nerve transfers for shoulder function for traumatic brachial plexus injuries. J Reconstr Microsurg 2014 ;30(01):59-64.

Kleyweg RP, van der Meche FG, Schmitz PI. Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barre syndrome. Muscle Nerve 1991; 14:1103-1109.

Merrell GA, Barrie KA, Katz DL, Wolfe SW. Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature. J Hand Surg 2001;26(2):303-314.

Favila A, Estrella E. Nerve Transfers for Shoulder Function for Traumatic Brachial Plexus Injuries. J Reconstr Microsurg 2013; 30(01):59-64.

Xiao F, Zhao X, Lao J. Comparative study of single and dual nerve transfers for repairing shoulder abduction. Acta Neurochirurgica 2019;161:673-678.

Garg R, Merrell GA, Hillstrom HJ, Wolfe SW. Comparison of Nerve Transfers and Nerve Grafting for Traumatic Upper Plexus Palsy: A Systematic Review and Analysis. J Bone Joint Surg Am 2011; 93(9):819-829.

Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P, Malungpaishrope K. Combined nerve transfers for C5 and C6 brachial plexus avulsion injury. J Hand Surg Am 2006;31:183-187.

Bertelli JA, Ghizoni MF.Reconstruction of C5 and C6 brachial plexus avulsion injury by multiple nerve transfers: spinal accessory to suprascapular, ulnar fascicles to biceps branch, and triceps long or lateral head branch to axillary nerve.J Hand Surg Am 2004; 29(1);131-139.

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Published

2021-08-04

How to Cite

Muhammad Ali, Tehseen Ahmad Cheema, Muhammad Khizer Hayat Makki, Hussan Birkhez Shami, Baqir Hussain, & Hafiz Muhammad Ahmad Qureshi. (2021). Outcome of Dual Nerve Transfer in C5-C6 Brachial Plexus Injuries. Journal of Pakistan Orthopaedic Association, 33(03), 107–111. Retrieved from http://jpoa.org.pk/index.php/upload/article/view/551