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Lower subscapular nerve transfer for axillary nerve repair in upper brachial plexus palsy

  • Original Article - Peripheral Nerves
  • Published:
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Abstract

Background

The potential to utilize the lower subscapular nerve for brachial plexus surgery has been suggested in many anatomical studies. However, we know of no studies in the literature describing the use of the lower subscapular nerve for axillary nerve reconstruction to date. This study aimed to examine the effectiveness of this nerve transfer in patients with upper brachial plexus palsy.

Methods

Of 1340 nerve reconstructions in 568 patients with brachial plexus injury performed by the senior author (P.H.), a subset of 18 patients underwent axillary nerve reconstruction using the lower subscapular nerve and constitutes the patient group for this study. The median age was 48 years, and the median time between trauma and surgery was 6 months. A concomitant radial nerve injury was found in 8 patients.

Results

Thirteen patients completed a minimum follow-up period of 24 months. Successful deltoid recovery was defined as (1) muscle strength MRC grade ≥ 3, (2) electromyographic signs of reinnervation, and (3) increase in deltoid muscle mass. Axillary nerve reconstruction was successful in 9 of 13 patients, which represents a success rate of 69.2%. No significant postoperative weakness of shoulder internal rotation or adduction was observed after transecting the lower subscapular nerve.

Conclusions

The lower subscapular nerve can be used as a safe and effective neurotization tool for upper brachial plexus injury, having a success rate of 69.2% for axillary nerve repair. Our technique presents a suitable alternative for patients with concomitant radial nerve injury.

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References

  1. Chen LZ, Chen L, Zhu Y, Gu YD (2013) Semiquantifying of fascicles of the C7 spinal nerve in the upper and lower subscapular nerves innervating the subscapularis and its clinical inference in Erb’s palsy. Clin Anat 26(4):470–475

    Article  Google Scholar 

  2. Forli A, Bouyer M, Aribert M, Curvale C, Delord M, Corcella D, Moutet F (2017) Upper limb nerve transfers: a review. Hand Surg Rehabil 36(3):151–172

    Article  CAS  Google Scholar 

  3. Haninec P, Kaiser R (2012) Axillary nerve repair by fascicle transfer from the ulnar or median nerve in upper brachial plexus palsy. J Neurosurg 117(3):610–614

    Article  Google Scholar 

  4. Haninec P, Mencl L, Kaiser R (2013) End-to-side neurorrhaphy in brachial plexus reconstruction. J Neurosurg 119(3):689–694

    Article  Google Scholar 

  5. Hultgren T, Einarsson F, Runesson E, Hemlin C, Fridén J, Ljung B-O (2010) Structural characteristics of the subscapularis muscle in children with medial rotation contracture of the shoulder after obstetric brachial plexus injury. J Hand Surg 35(1):23–28

    Article  CAS  Google Scholar 

  6. Leechavengvongs S, Teerawutthichaikit T, Witoonchart K, Uerpairojkit C, Malungpaishrope K, Suppauksorn S, Chareonwat B (2015) Surgical anatomy of the axillary nerve branches to the deltoid muscle. Clin Anat 28:118–122

    Article  Google Scholar 

  7. Leschinger T, Hackl M, Zeifang F, Scaal M, Müller LP, Wegmann K (2017) Nerve supply of the subscapularis during anterior shoulder surgery: definition of a potential risk area. Arch Orthop Trauma Surg 137(1):135–140

    Article  Google Scholar 

  8. Lurje A (1948) Concerning surgical treatment of traumatic injury to the upper division of the brachial plexus (Erb’s Type). Ann Surg 127(2):317–326

    Article  Google Scholar 

  9. Mencl L, Waldauf P, Haninec P (2015) Results of nerve reconstructions in treatment of obstetrical brachial plexus injuries. Acta Neurochir 157(4):673–680

    Article  Google Scholar 

  10. Ray WZ, Chang J, Hawasli A, Wilson TJ, Yang L (2015) Motor nerve transfers: a comprehensive review. Neurosurgery 78(1):1–25

    Article  Google Scholar 

  11. Saleh DB, Callear J, McConnell P, Kay SPJ (2012) The anatomy of the subscapular nerves: a new nomenclature. J Plast Reconstr Aesthet Surg 65(8):1072–1075

    Article  CAS  Google Scholar 

  12. Samardzic M, Rasulic LG, Grujicic DM, Bacetic DT, Milicic BR (2011) Nerve transfers using collateral branches of the brachial plexus as donors in patients with upper palsy-thirty years’ experience. Acta Neurochir 153(10):2009–2019

    Article  Google Scholar 

  13. Tötösy de Zepetnek JE, Zung HV, Erdebil S, Gordon T (1992) Innervation ratio is an important determinant of force in normal and reinnervated rat tibialis anterior muscles. J Neurophysiol 67(5):1385–1403

    Article  Google Scholar 

  14. Tubbs RS, Khoury CA, Salter EG, Acakpo-Satchivi L, Wellons JC, Blount JP, Oakes WJ (2006) Quantitation of the lower subscapular nerve for potential use in neurotization procedures. J Neurosurg 105(6):881–883

    Article  Google Scholar 

  15. Tubbs RS, Loukas M, Shahid K, Judge T, Pinyard J, Shoja MM, Slappey JB, McEvoy WC, Oakes WJ (2007) Anatomy and quantitation of the subscapular nerves. Clin Anat 20(6):656–659

    Article  Google Scholar 

  16. Yang LJS, Chang KWC, Chung KC (2012) A systematic review of nerve transfer and nerve repair for the treatment of adult upper brachial plexus injury. Neurosurgery 71(2):417–429

    Article  Google Scholar 

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Acknowledgments

The authors thank Mr. Ivan Helekal for the artwork presented in Fig. 1.

Funding

This study was supported by Charles University in Prague, Progres Q35 and EU Structural Funds OPP competitiveness (grant no. CZ.2.16./3.1.00/21532).

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Authors and Affiliations

  1. Department of Neurosurgery, 3rd Faculty of Medicine, Charles University Hospital Kralovske Vinohrady, Srobarova 50, 100 34, Prague, Czech Republic

    Pavel Haninec, Jan Hradecky & Libor Mencl

Authors
  1. Pavel Haninec
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  2. Jan Hradecky
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  3. Libor Mencl
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Contributions

Conception, design, and study supervision: Haninec. Acquisition, analysis, and interpretation of data: Mencl. Drafting the article: Mencl. Critically revising the article: all authors.

Corresponding author

Correspondence to Libor Mencl.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Vinohrady Hospital research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study formal consent is not required.

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Comments

The authors describe a unique experience. The use of the subscapular nerve for reinnervating a brachial plexus injury has been described in the older literature. Unfortunately, there is no record of long-term results from this transfer. The authors successfully used the subscapular nerve to reinnervate the axillary nerve in 69.2% of their patients. In all of these patients, the radial nerve was not available for the standard radial to axillary nerve transfer. I am uncertain how often the radial nerve will not be available, but the subscapular nerve will still carry function. Neurosurgeons have had great success over the past 25 years using nerve transfers for restoring the proximal brachial plexus. The authors describe a very valuable technique which can be added to our armamentarium.

Allan Friedman

NC, USA

An interesting article that adds another neurotization surgical option to the peripheral nerve surgeon’s growing armamentarium.

Michel Kliot

CA, USA

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This article is part of the Topical Collection on Peripheral Nerves

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Haninec, P., Hradecky, J. & Mencl, L. Lower subscapular nerve transfer for axillary nerve repair in upper brachial plexus palsy. Acta Neurochir 162, 135–139 (2020). https://doi.org/10.1007/s00701-019-04122-w

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  • DOI: https://doi.org/10.1007/s00701-019-04122-w

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