Article
Triple nerve transfers for the C5/6 Brachial Plexus injury
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Published: | February 6, 2020 |
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Objectives/Interrogation: Assess the functional results of triple nerve transfers for the C5/6 Brachial Plexus injury as a single stage procedure from the dorsal approach to decrease the recovery time post nerve transfers.
Methods: All adult patients who presented to our institution in four two years with loss of C5 and C6 after the Brachial plexus Avulsion injury and where primary repair was not possible underwent the Nerve transfers to reconstruct the shoulder abduction, external rotation and elbow flexion as a single stage procedure. Dorsal approach to the spinal accessory nerve was used for neurotization to the SSN, Radial nerve branch to the long head of triceps was used to restore the axillary nerve function and single fascicle of ulnar nerve to the wrist flexor was utilized to target the MCN nerve to the biceps muscle. The patients were follow- up at 6 weeks, 3 months, 6 months, 1 year and 2 years. The muscle charting was done with MRC grading.
Results and Conclusions: We currently have done 21 patients with C5/6 Brachial plexus injury which received triple nerve transfers and early results shows the return of biceps function an average of 5 months, the shoulder abduction and external rotation functional recovery is incomplete but functional at 6 months and improved up to 18 months post-operatively.
Loss of shoulder abduction, external rotation can be reconstructed as a single stage procedure from the dorsal approach to the spinal accessory & radial nerve, and Oberlin transfer for elbow flexion from volar approach, this has decreased the recovery time as nerve transfers are possible near the target muscles.