gms | German Medical Science

Objectives/Interrogation: Deltoid paralysis follows injury to the C5 nerve root or the axillary nerve. Nerve transfer provides a reliable method of restoration of function and typically the donor nerve is from one of the triceps branches. The technique has evolved from the description of triceps to axillary nerve transfer through an anterior approach (Stoffel 1911) to the modifications of the posterior approach using the medial triceps branch (Mackinnon). The rationale for the technique evolution is defined with an algorithm for reconstruction.

Methods: A review of literature on nerve transfer to the deltoid was undertaken to develop an algorithm for reconstruction of axillary nerve function. The results of this algorithm were evaluated using the outcomes of 60 consecutive nerve transfers to deltoid performed in a specialist nerve injury service.

Results and Conclusions: The medial nerve to triceps is now the favoured donor nerve for restoration of axillary nerve function in isolated C5, C5 and C6 combined and isolated high-grade axillary nerve injury or rupture. The nerve is sutured to the main axillary nerve to reinnervate deltoid and teres minor when necessary. The avoidance of the long head triceps branch maintains the only intact shoulder stabilising muscle in the C5 and C6 combined injury and is now the preferred donor in all nerve transfers to deltoid; due to the higher motor axon count, the length of the donor allowing closer placement of the neurorrhaphy to the motor point and the low donor morbidity. In cases of associated C7 dysfunction or isolated posterior cord injury, the FCU fascicle of the ulnar nerve is the preferred donor nerve and the procedure is undertaken through a posterior approach. The nerve transfer to deltoid is performed synchronously with a posterior spinal accessory to suprascapular nerve transfer in cases of C5 complete injury.

The current reconstructive algorithm for deltoid function is effective and allows rapid reinnervation without loss of stabilising function of the long head of triceps at the glenohumeral joint.