Artikel
Radial nerve innervation to deltoid muscle – technical note on the example of an illustrative case on radial to axillary transfer in neuralgic amyotrophy of the shoulder
Innervation des Deltoideus-Muskel durch den Nervus radialis: ein technischer Bericht über den Transfer vom Nervus radialis auf den Nervus axillaris bei einer neuralgischen Schulteramyotrophy
Suche in Medline nach
Autoren
Veröffentlicht: | 25. Mai 2022 |
---|
Gliederung
Text
Objective: Neuralgic shoulder amyotrophy (Personage Turner Syndrome, PTS) is a rare and acute neuropathy of the brachial plexus. Up to 89% are completely relieved of all symptoms after 3 years, while the rest retain residual paresis. While nerve transfers have been performed since the 1980s to re-innervate paretic muscles in cases of traumatic injury to the nerve roots and brachial plexus, this surgical treatment option has not yet become available in cases of persistent paralysis in Personage Turner Syndrome and surgical treatment options are poorly characterized in the medical literature. Loss of active shoulder abduction after neuralgic shoulder amyotrophy in cases of isolated axillary nerve affection is associated with a severe functional deficit. This is a technical note of the surgical procedure of axillary nerve neurotization by a triceps motor branch. Nerve split transfer of the long head of triceps (radial nerve) to the axillary nerve is the technique of choice for re-innervation of the deltoid muscle not only in traumatic lesions but also in cases of persistent paralysis due to neuropathy of the upper brachial plexus.
Methods: Case report of a 16 years male patient with acute PTS and persistent axillary nerve palsy with deltoid muscle atrophy. Nerve split transfer of the long head of triceps (radial nerve) to the axillary nerve as technique of choice for re-innervation of the deltoid muscle. Pre- and postoperative motor function, movement extent and subjective perception was evaluated 6 and 12 months postoperatively.
Results: 6 months after the operation there was already an objective and subjective improvement. After 12 months, the patient’s motor exam improved from a Medical Research Council scale 1 to 4+ for deltoid function with greater than 90° of shoulder abduction.
Conclusion: Nerve split transfer is a promising method to restore arm-shoulder function not only in traumatic lesions but also in neuralgic shoulder amyotrophy with persistent deltoid atrophy. Patients must be carefully selected and spontaneous recovery should be waited.