Accessory nerve to suprascapular nerve transfer in obstetrical brachial plexus palsy: preliminary results in 10 cases
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Published:
May 11, 2015
Keywords:
Brachial plexus, Obstetrical palsy, Nerve transfers, Neurotization, Accessory spinal nerve, . Supraescapular nerve
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Abstract
BackgroundTo evaluate the preliminary results of spinal accessory nerve to suprascapular nerve transfer in obstetric brachial plexus palsy.MethodsBetween 2010 and 2012, 16 transfers of spinal accessory nerve to suprascapular nerve were performed in obstetric brachial plexus palsy. Ten patients with a minimum follow-up of 18 months were included. Values of muscle power were assessed according to the Gilbert scale, and functional scales of the shoulder (Mallet and Gilbert) were used. Preoperative and postoperative values, and the differences between partial and total paralysis results were compared. Student test was used for the statistical analysis.ResultsThe average follow-up was 20.9 months. Preoperative shoulder abduction power was 0.48 M, preoperative external rotation power was 0 M, and those values at the end of the follow-up were 2.70 M and 2.4 M, respectively. All patients had type 1 patterns of the Gilbert and Mallet scales, with mean postoperative values of 3.2 and 3.5, respectively. Statistically significant differences were found between these values.ConclusionsLimitations of this preliminary report are the short follow-up and the low number of cases. However, the functional results obtained are consistent with those from other reports, and they support the use of the spinal accessory neve to suprascapular nerve transfer in brachial plexus reconstructions requiring an extra-plexual contribution.
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Valbuena, S. E. (2015). Accessory nerve to suprascapular nerve transfer in obstetrical brachial plexus palsy: preliminary results in 10 cases. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 80(2), 113-120. https://doi.org/10.15417/295
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Clinical Research
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References
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Acta Orthop 2011;82:482-8.
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palsy (OBPP) and rehabilitation. En: Gilbert A (ed.) Brachial plexus injuries, London: Martin Dunitz; 2001:173-87.
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Taylor & Francis; 2005:471-514.
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2001:205-10.
5. Dogliotti A. Remodelación de la articulación glenohumeral en la deformidad tipo IV de la parálisis braquial obstétrica.
Resultados clínicos y morfológicos luego de la liberación extrarticular del hombro y transferencia de los rotadores internos.
Rev Asoc Argent Ortop Traumatol 2010;75(4):357-62.
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7. Gilbert A, Brockman R, Carlioz H. Surgical treatment of brachial plexus palsy. Clin Ortho Relat Res 1991;264:39-47.
8. Gilbert A, Khouri N, Carlioz H. Birth palsy of the brachial plexus: surgical exploration and attempted repair in 21 cases.
Rev Chir Ortho Reparatrice Appar Mot 1991;66:33-42.
9. Clarke HM, Curtis CG. An approach to obstetrical brachial plexus injuries. Hand Clin 1995;11:563-80.
10. Hale HB, Bae DS, Waters PM. Current concepts in the management of brachial plexus birth palsy. J Hand Surg Am
2010;35:322-31.
11. Hoeksma AF, Wolf H, Oei SL. Obstetrical brachial plexus injuries: incidence, natural course and shoulder contracture.
Clin Rehabil 2000;14:523-26.
12. Marcus JR, Clarke HM. Management of obstetrical brachial plexus palsy. Evaluation, prognosis, and primary surgical
treatment. Clin Plastic Surg 2003;30:289-306.
13. Waters PM. Comparison of the natural history, the outcome of microsurgical repair, and the outcome of operative reconstruction
in brachial plexus birth palsy. J Bone Joint Surg Am 1999;81:649-59.
14. Zancolli EA, Zancolli ER Jr. Palliative surgical procedures in sequelae of obstetric palsy. Hand Clin 1988;4:643-69.
15. Terzis JK, Kokkalis ZT. Shoulder function following primary axillary nerve reconstruction in obstetrical brachial plexus
patients. Plast Reconstr Surg 2008;122:1457-69.
16. Narakas AO. Obstetrical brachial plexus injuries. En: Lamb DW (ed.) The paralysed hand, Edinburgh: Churchill Livingstone;
1987:116-35.
17. Gilbert A, Tassin JL. [Surgical repair of the brachial plexus in obstetric paralysis]. Chirurgie 1984;110:70-5.
18. Bae DS, Waters PM, Zurakowski D. Reliability of three classification systems measuring active motion in brachial plexus birth
palsy. J Bone Joint Surg Am 2003;85:1733-8.
19. Dailiana ZH, Mehdian H, Gilbert A. Surgical anatomy of spinal accessory nerve is trapezius functional deficit inevitable after
division of the nerve? J Hand Surg Br 2001;26(2):137-41.
20. Al-Qattan MM, El-Shayeb A. Identification of the spinal accessory nerve within the surgical field during primary exploration
of the brachial plexus in infants with obstetric palsy. J Hand Surg Am 2005;30:808-11.
21. Bertelli JA, Ghizoni MF. Transfer of the accessory nerve to the suprascapular nerve in brachial plexus reconstruction. J Hand
Surg Am 2007;32:989-98.
22. Muset I, Lara A, Dolz C, Rodriguez-Baeza A. Anatomy of the brachial plexus. En: Gilbert A (ed.) Brachial plexus injuries,
London: Martin Dunitz; 2001:3-15.
23. Zancolli EA, Cozzi EP. Nervios de la extremidad superior. II Plexo braquial (topografía funicular en las partes indivisas y
aplicaciones quirúrgicas). En: Zancolli EA, Cozzi EP (eds.) Atlas de anatomía quirúrgica de la mano, Buenos Aires y Madrid:
Editorial Médica Panameriana; 1993:652-60.
24. Borrero JL. Obstetrical paralysis. Surgical technique. En: Gilbert A (ed.) Brachial plexus injuries, London: Martin Dunitz;
2001:189-204.
25. Alnot JY, Oberlin C. [Surgical anatomy of the accessory nerve]. En: Alnot JY, Narakas AO (eds.) Les paralysies du plexus
brachial, Paris: Expansion Scientifique Française; 1995:33-9.
26. Hattori Y, Doi K, Toh S, Baliarsing AS. Surgical approach to the spinal accessory nerve for brachial plexus reconstruction.
J Hand Surg Am 2001;26:1073-76
27. 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;29:131-9.
28. Tse R, Marcus JR, Curtis CG, Dupuis A, Clarke HM. Suprascapular nerve reconstruction in obstetrical brachial plexus palsy:
spinal accessory nerve transfer versus C5 root grafting. Plast Reconstr Surg 2011;127:2391-6.
29. van Ouwerkerk WJ, Uitdehaag BM, Strijers RL, Frans N, Holl K, Fellner FA, et al. Accessory nerve to suprascapular nerve
transfer to restore shoulder exorotation in otherwise spontaneously recovered obstetric brachial plexus lesions. Neurosurgery
2006;59:858-67.
30. Pondaag W, de Boer R, van Wijlen-Hempel MS, Hofstede-Buitenhuis SM, Malessy MJ. External rotation as a result of
suprascapular nerve neurotization in obstetrical brachial plexus lesions. Neurosurgery 2005;57:530-7
Acta Orthop 2011;82:482-8.
2. Muhlig RS, Blaauw G, Slooff ACJ, Kortleve JW, Tonino AJ. Obstetrical paralysis. Conservative treatment of brachial plexus
palsy (OBPP) and rehabilitation. En: Gilbert A (ed.) Brachial plexus injuries, London: Martin Dunitz; 2001:173-87.
3. Gilbert A. Obstetrical paralysis. En: Tubiana R, Gilbert A (eds.). Tendon, nerve and other disorders, London and New York:
Taylor & Francis; 2005:471-514.
4. Gilbert A. Obstetrical paralysis. Indication and strategy. En: Gilbert A (ed.) Brachial plexus injuries, London: Martin Dunitz;
2001:205-10.
5. Dogliotti A. Remodelación de la articulación glenohumeral en la deformidad tipo IV de la parálisis braquial obstétrica.
Resultados clínicos y morfológicos luego de la liberación extrarticular del hombro y transferencia de los rotadores internos.
Rev Asoc Argent Ortop Traumatol 2010;75(4):357-62.
6. Gilbert A. Long-term evaluation of brachial plexus surgery in obstetrical palsy. Hand Clin 1995;11:583-94.
7. Gilbert A, Brockman R, Carlioz H. Surgical treatment of brachial plexus palsy. Clin Ortho Relat Res 1991;264:39-47.
8. Gilbert A, Khouri N, Carlioz H. Birth palsy of the brachial plexus: surgical exploration and attempted repair in 21 cases.
Rev Chir Ortho Reparatrice Appar Mot 1991;66:33-42.
9. Clarke HM, Curtis CG. An approach to obstetrical brachial plexus injuries. Hand Clin 1995;11:563-80.
10. Hale HB, Bae DS, Waters PM. Current concepts in the management of brachial plexus birth palsy. J Hand Surg Am
2010;35:322-31.
11. Hoeksma AF, Wolf H, Oei SL. Obstetrical brachial plexus injuries: incidence, natural course and shoulder contracture.
Clin Rehabil 2000;14:523-26.
12. Marcus JR, Clarke HM. Management of obstetrical brachial plexus palsy. Evaluation, prognosis, and primary surgical
treatment. Clin Plastic Surg 2003;30:289-306.
13. Waters PM. Comparison of the natural history, the outcome of microsurgical repair, and the outcome of operative reconstruction
in brachial plexus birth palsy. J Bone Joint Surg Am 1999;81:649-59.
14. Zancolli EA, Zancolli ER Jr. Palliative surgical procedures in sequelae of obstetric palsy. Hand Clin 1988;4:643-69.
15. Terzis JK, Kokkalis ZT. Shoulder function following primary axillary nerve reconstruction in obstetrical brachial plexus
patients. Plast Reconstr Surg 2008;122:1457-69.
16. Narakas AO. Obstetrical brachial plexus injuries. En: Lamb DW (ed.) The paralysed hand, Edinburgh: Churchill Livingstone;
1987:116-35.
17. Gilbert A, Tassin JL. [Surgical repair of the brachial plexus in obstetric paralysis]. Chirurgie 1984;110:70-5.
18. Bae DS, Waters PM, Zurakowski D. Reliability of three classification systems measuring active motion in brachial plexus birth
palsy. J Bone Joint Surg Am 2003;85:1733-8.
19. Dailiana ZH, Mehdian H, Gilbert A. Surgical anatomy of spinal accessory nerve is trapezius functional deficit inevitable after
division of the nerve? J Hand Surg Br 2001;26(2):137-41.
20. Al-Qattan MM, El-Shayeb A. Identification of the spinal accessory nerve within the surgical field during primary exploration
of the brachial plexus in infants with obstetric palsy. J Hand Surg Am 2005;30:808-11.
21. Bertelli JA, Ghizoni MF. Transfer of the accessory nerve to the suprascapular nerve in brachial plexus reconstruction. J Hand
Surg Am 2007;32:989-98.
22. Muset I, Lara A, Dolz C, Rodriguez-Baeza A. Anatomy of the brachial plexus. En: Gilbert A (ed.) Brachial plexus injuries,
London: Martin Dunitz; 2001:3-15.
23. Zancolli EA, Cozzi EP. Nervios de la extremidad superior. II Plexo braquial (topografía funicular en las partes indivisas y
aplicaciones quirúrgicas). En: Zancolli EA, Cozzi EP (eds.) Atlas de anatomía quirúrgica de la mano, Buenos Aires y Madrid:
Editorial Médica Panameriana; 1993:652-60.
24. Borrero JL. Obstetrical paralysis. Surgical technique. En: Gilbert A (ed.) Brachial plexus injuries, London: Martin Dunitz;
2001:189-204.
25. Alnot JY, Oberlin C. [Surgical anatomy of the accessory nerve]. En: Alnot JY, Narakas AO (eds.) Les paralysies du plexus
brachial, Paris: Expansion Scientifique Française; 1995:33-9.
26. Hattori Y, Doi K, Toh S, Baliarsing AS. Surgical approach to the spinal accessory nerve for brachial plexus reconstruction.
J Hand Surg Am 2001;26:1073-76
27. 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;29:131-9.
28. Tse R, Marcus JR, Curtis CG, Dupuis A, Clarke HM. Suprascapular nerve reconstruction in obstetrical brachial plexus palsy:
spinal accessory nerve transfer versus C5 root grafting. Plast Reconstr Surg 2011;127:2391-6.
29. van Ouwerkerk WJ, Uitdehaag BM, Strijers RL, Frans N, Holl K, Fellner FA, et al. Accessory nerve to suprascapular nerve
transfer to restore shoulder exorotation in otherwise spontaneously recovered obstetric brachial plexus lesions. Neurosurgery
2006;59:858-67.
30. Pondaag W, de Boer R, van Wijlen-Hempel MS, Hofstede-Buitenhuis SM, Malessy MJ. External rotation as a result of
suprascapular nerve neurotization in obstetrical brachial plexus lesions. Neurosurgery 2005;57:530-7