Skip to main content
Erschienen in: HAND 2/2006

01.12.2006 | Original Article

Posterior Approach for Double Nerve Transfer for Restoration of Shoulder Function in Upper Brachial Plexus Palsy

verfasst von: Stephen H. Colbert, Susan Mackinnon

Erschienen in: HAND | Ausgabe 2/2006

Einloggen, um Zugang zu erhalten

Abstract

Restoration of shoulder function is one of the most critical goals of treatment of brachial plexus injuries. Primary repair or nerve grafting of avulsion injuries of the upper brachial plexus in adults often leads to poor recovery. Nerve transfers have provided an alternative treatment with great potential for improved return of function. Many different nerves have been utilized as donor nerves for transfer to the suprascapular nerve and axillary nerve for return of shoulder function with variable results. As our knowledge of shoulder neuromuscular anatomy and physiology improves and our experience with nerve transfers increases, so evolve the specific transfer procedures. This article presents a technique and rationale for reconstructing shoulder function by transferring the distal spinal accessory nerve to the suprascapular nerve and the nerve branch to the medial head of the triceps to the axillary nerve, both through a posterior approach.
Literatur
1.
Zurück zum Zitat Bahm J, Naoman H, Becker M. The dorsal approach to the suprascapular nerve in neuromuscular reanimation for obstetric brachial plexus lesions. Plast Reconstr Surg 2005;115:240–4.PubMed Bahm J, Naoman H, Becker M. The dorsal approach to the suprascapular nerve in neuromuscular reanimation for obstetric brachial plexus lesions. Plast Reconstr Surg 2005;115:240–4.PubMed
2.
Zurück zum Zitat 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 2004;29A:131–9. 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 2004;29A:131–9.
3.
Zurück zum Zitat Bertelli JA, Ghizoni MF. Improved technique for harvesting the accessory nerve for transfer in brachial plexus injuries. Neurosurgery 2006;58(4) Suppl 2:ONS-366-70; discussion ONS-370. Bertelli JA, Ghizoni MF. Improved technique for harvesting the accessory nerve for transfer in brachial plexus injuries. Neurosurgery 2006;58(4) Suppl 2:ONS-366-70; discussion ONS-370.
4.
Zurück zum Zitat Brushart TME. Preferential reinnervation of motor nerves by regenerating motor axons. J Neurosci 1988;8:1026–31.PubMed Brushart TME. Preferential reinnervation of motor nerves by regenerating motor axons. J Neurosci 1988;8:1026–31.PubMed
5.
Zurück zum Zitat Celli L, Rovesta C, Balli A. Neurotization of brachial plexus avulsion with intercostal nerves (personal techniques). In: Brunelli G, editor. Textbook of microsurgery. Milano: Masson; 1988. p. 789–95. Celli L, Rovesta C, Balli A. Neurotization of brachial plexus avulsion with intercostal nerves (personal techniques). In: Brunelli G, editor. Textbook of microsurgery. Milano: Masson; 1988. p. 789–95.
6.
Zurück zum Zitat Chuang DC-C, Lee GW, Hashem F, Wei F-C. Restoration of shoulder abduction by nerve transfer in avulsion brachial plexus injury: evaluation of 99 patients with various nerve transfers. Plast Reconstr Surg 1995;96:122–8.CrossRefPubMed Chuang DC-C, Lee GW, Hashem F, Wei F-C. Restoration of shoulder abduction by nerve transfer in avulsion brachial plexus injury: evaluation of 99 patients with various nerve transfers. Plast Reconstr Surg 1995;96:122–8.CrossRefPubMed
7.
Zurück zum Zitat Gu YD, Cai PQ, Xu F, Peng F, Chen L. Clinical application of ipsilateral C7 nerve root transfer for treatment of C5 and C6 avulsion of brachial plexus. Microsurgery 2003;23(2):105–8.CrossRefPubMed Gu YD, Cai PQ, Xu F, Peng F, Chen L. Clinical application of ipsilateral C7 nerve root transfer for treatment of C5 and C6 avulsion of brachial plexus. Microsurgery 2003;23(2):105–8.CrossRefPubMed
8.
Zurück zum Zitat Gu YD, Zhang GM, Chen DS, Cheng XM, Zhang LY, Yan JG, Cai PQ, Shen LY. Cervical nerve root transfer from contralateral normal side for treatment of brachial plexus root avulsions. Chin Med J 1991;104:208–11.PubMed Gu YD, Zhang GM, Chen DS, Cheng XM, Zhang LY, Yan JG, Cai PQ, Shen LY. Cervical nerve root transfer from contralateral normal side for treatment of brachial plexus root avulsions. Chin Med J 1991;104:208–11.PubMed
9.
Zurück zum Zitat Hartrampf CR, Elliott LF, Feldman S. A triceps musculocutaneous flap for chest-wall defects. Plast Reconstr Surg 1990;86:502–9.CrossRefPubMed Hartrampf CR, Elliott LF, Feldman S. A triceps musculocutaneous flap for chest-wall defects. Plast Reconstr Surg 1990;86:502–9.CrossRefPubMed
10.
Zurück zum Zitat Kawai H, Akita S. Shoulder muscle reconstruction in the upper type of the brachial plexus injury by partial radial nerve transfer to the axillary nerve. Tech Hand Up Extrem Surg 2004;8:51–5.CrossRefPubMed Kawai H, Akita S. Shoulder muscle reconstruction in the upper type of the brachial plexus injury by partial radial nerve transfer to the axillary nerve. Tech Hand Up Extrem Surg 2004;8:51–5.CrossRefPubMed
11.
Zurück zum Zitat Kline DG, Hudson AR. Stretch injuries to the brachial plexus. In: Kline DG, Hudson AR eds. Nerve injuries: operative results for major nerve injuries, entrapments, and tumors. Philadelphia: Saunders; 1995, 135: p. 415–6. Kline DG, Hudson AR. Stretch injuries to the brachial plexus. In: Kline DG, Hudson AR eds. Nerve injuries: operative results for major nerve injuries, entrapments, and tumors. Philadelphia: Saunders; 1995, 135: p. 415–6.
12.
Zurück zum Zitat Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P. Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases. J Hand Surg 2003;28A:633–8. Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P. Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases. J Hand Surg 2003;28A:633–8.
13.
Zurück zum Zitat Lurje A. Concerning surgical treatment of traumatic injury of the upper division of the brachial plexus (Erb's-type). Ann Surg 1948;127:317–26.CrossRef Lurje A. Concerning surgical treatment of traumatic injury of the upper division of the brachial plexus (Erb's-type). Ann Surg 1948;127:317–26.CrossRef
14.
Zurück zum Zitat Mackinnon SE, Novak CB. Nerve transfers. New options for reconstruction following nerve injury. Hand Clin 1999;15:643–66.PubMed Mackinnon SE, Novak CB. Nerve transfers. New options for reconstruction following nerve injury. Hand Clin 1999;15:643–66.PubMed
15.
Zurück zum Zitat Mackinnon SE, Novak CB, Myckatyn TM, Tung TH. Results of reinnervation of the biceps and brachialis muscles with a double fascicular transfer for elbow flexion. J Hand Surg 2005;30A:978–85. Mackinnon SE, Novak CB, Myckatyn TM, Tung TH. Results of reinnervation of the biceps and brachialis muscles with a double fascicular transfer for elbow flexion. J Hand Surg 2005;30A:978–85.
16.
Zurück zum Zitat Malessy MJA, Hoffmann CFE, Thomeer RTWM. Initial report on the limited value of hypoglossal nerve transfer to treat brachial plexus root avulsions. J Neurosurg 1999;91:601–4.PubMed Malessy MJA, Hoffmann CFE, Thomeer RTWM. Initial report on the limited value of hypoglossal nerve transfer to treat brachial plexus root avulsions. J Neurosurg 1999;91:601–4.PubMed
17.
Zurück zum Zitat 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;26A:303–14. 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;26A:303–14.
18.
Zurück zum Zitat Nath RK, Mackinnon SE. Nerve transfers in the upper extremity. Hand Clin 2000;16:131–9.PubMed Nath RK, Mackinnon SE. Nerve transfers in the upper extremity. Hand Clin 2000;16:131–9.PubMed
19.
Zurück zum Zitat Oberlin C, Beal D, Leechavengvongs S, Salon A, Dauge MC, Sarcy JJ. Nerve transfer to biceps muscle using a part of ulnar nerve for C5–C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg 1994;19A (2):232–7, Mar. Oberlin C, Beal D, Leechavengvongs S, Salon A, Dauge MC, Sarcy JJ. Nerve transfer to biceps muscle using a part of ulnar nerve for C5–C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg 1994;19A (2):232–7, Mar.
20.
Zurück zum Zitat Samardzic M, Grujicic D, Antunovic V. Nerve transfer in brachial plexus traction injuries. J Neurosurg 1992;76(2):191–7, Feb.PubMedCrossRef Samardzic M, Grujicic D, Antunovic V. Nerve transfer in brachial plexus traction injuries. J Neurosurg 1992;76(2):191–7, Feb.PubMedCrossRef
21.
Zurück zum Zitat Samardzic M, Grujicic D, Rasulic L, Bacetic D. Transfer of the medial pectoral nerve: myth or reality? Neurosurgery 2002; 50:1277–82.CrossRefPubMed Samardzic M, Grujicic D, Rasulic L, Bacetic D. Transfer of the medial pectoral nerve: myth or reality? Neurosurgery 2002; 50:1277–82.CrossRefPubMed
22.
Zurück zum Zitat Tung TH, Novak CB, Mackinnon SE. Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries. J Neurosurg 2003;98:313–8.PubMed Tung TH, Novak CB, Mackinnon SE. Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries. J Neurosurg 2003;98:313–8.PubMed
23.
Zurück zum Zitat Van Groeningen CJ, Erkelens CJ. Task-dependent difference between mono- and bi-articular heads of the triceps brachii muscle. Exp Brain Res 1994;100:345–52.CrossRefPubMed Van Groeningen CJ, Erkelens CJ. Task-dependent difference between mono- and bi-articular heads of the triceps brachii muscle. Exp Brain Res 1994;100:345–52.CrossRefPubMed
24.
Zurück zum Zitat Witoonchart K, Leechavengvongs S, Uerpairojkit C, Thuvasethakul P, Wongnopsuwan V. Nerve transfer to deltoid muscle using the nerve to the long head of the triceps: part I. An anatomic feasibility study. J Hand Surg 2003;28A:628–32. Witoonchart K, Leechavengvongs S, Uerpairojkit C, Thuvasethakul P, Wongnopsuwan V. Nerve transfer to deltoid muscle using the nerve to the long head of the triceps: part I. An anatomic feasibility study. J Hand Surg 2003;28A:628–32.
Metadaten
Titel
Posterior Approach for Double Nerve Transfer for Restoration of Shoulder Function in Upper Brachial Plexus Palsy
verfasst von
Stephen H. Colbert
Susan Mackinnon
Publikationsdatum
01.12.2006
Verlag
Springer-Verlag
Erschienen in
HAND / Ausgabe 2/2006
Print ISSN: 1558-9447
Elektronische ISSN: 1558-9455
DOI
https://doi.org/10.1007/s11552-006-9004-4

Weitere Artikel der Ausgabe 2/2006

HAND 2/2006 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.