ADEQUACY OF SHOULDER ABDUCTION AFTER SINGLE NERVE TRANSFER FOR BRACHIAL PLEXUS INJURY

Abstract

Objective: To describe the functional outcome of spinal accessory to supra-scapular nerve transfer procedure for shoulder abduction following closed brachial plexus injury.

Study Design: Case series.

Place and Duration of Study: Combined Military Hospital Rawalpindi from Jan 2013 to May 2014. (Nerve transfer operations during 6 months from Jan 2013 to July 2013, post-operative follow ups for 10 months till 31 May 2014).

Material and Methods: Military and civilian trauma patients presenting with loss of shoulder abduction following closed brachial plexus injury at plastic surgery outpatient department (OPD) and accident & emergency (A&E) were included in the study. For early presentations, clinical evaluations and nerve conduction
studies at 3 weeks and then again at 3 months after injury were done. For late presentations clinical evaluation and nerve conduction studies (NCS) were done and compared with previous data if available. Twelve patients that showed no recovery at least 3 months post-injury underwent spinal accessory to suprascapular single nerve transfer operation between 31 Jan 2013 to 31 July 2013 (6 months). Ten months post-operative follow up was done till 31 May 2014 and the shoulder abduction power was documented.

Results: All 12 patients were males. Mean age was 29 years. Age range was 22-41 years. Average time interval from trauma to operation was 5 months. Six (50%) patients achieved medical research council (MRC) grade 3-4 power shoulder abduction. Two (17%) patients achieved grade 1-2 power. Four (33%) patients did not show any improvement at 10 months.

Conclusion: Spinal accessory (SA) to supra-scapular (SS) nerve transfer is important shoulder stabilization operation and if done at appropriate time, can result in an acceptable shoulder function.