Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases 1

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Abstract

Purpose: This study reports the results of nerve transfer to the deltoid muscle using the nerve to the long head of the triceps.

Methods: Seven patients with an average age of 25 years with loss of shoulder abduction secondary to upper brachial plexus injuries had nerve transfer using the nerve to the long head of the triceps to the anterior branch(es) of the axillary nerve through the posterior approach. The spinal accessory nerve was used simultaneously for nerve transfer to the suprascapular nerve. The follow-up period ranged from 18 to 28 months (average, 20 mo).

Results: All patients recovered deltoid power against resistance (M4) at the last follow-up evaluation. Useful functional recovery was achieved in all 7 patients; 5 had excellent recoveries and 2 had good results. The average shoulder abduction was 124°. No notable weakness of elbow extension was observed.

Conclusions: This method is a reliable and effective procedure for deltoid reconstruction in brachial plexus injury (upper-arm type) and should be combined with spinal accessory nerve transfer to the suprascapular nerve to obtain good shoulder abduction.

Section snippets

Clinical data

The patient data are outlined in Table 1. Between August 2000 and June 2001 there were 7 patients with upper-arm-type brachial plexus injuries associated with motor vehicle accidents. Five patients were men and 2 were women; the patients’ ages ranged from 13 to 35 years (average, 25 y). The interval between injury and surgery ranged from 3 to 10 months (average, 7 mo). All patients had serial physical examinations and electrodiagnostic studies. They all had C5 and C6 root avulsions. They all

Results

Recovery of the deltoid grade M2 occurred between 6 and 8 months after surgery. All patients had recovered the deltoid against resistance (M4) at the last follow-up evaluation (average, 20 mo). Useful functional recovery was achieved in all 7 patients (100%), of which 5 (71%) experienced excellent recoveries and 2 (28%) were classified as a good result Figure 3, Figure 4. The mean shoulder abduction was 124°. Subluxation of the shoulders was eliminated in all patients. No patients had any

Discussion

In cases of C5 and C6 root avulsion in which nerve grafting was not possible the 3 remaining options for shoulder reconstruction are arthrodesis, tendon transfer, and nerve transfer. Although arthrodesis provides shoulder stability, it sacrifices mobility. It is difficult to get satisfactory shoulder abduction by one or multiple tendon/muscle transfers by using levator scapulae, trapezius, sternocleidomastoid, or latissimus dorsi muscles.1, 12, 13 Although Aziz et al14 reported the results of

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