Abstract
Background Optimal dynamic reconstruction of shoulder function requires a functional suprascapular
nerve (SSN). Nerve transfer of the distal spinal accessory nerve (dSAN) to the SSN
will in many cases restore very good supraspinatus and infraspinatus function. One
potential cause of failure of this nerve transfer is an unrecognized more distal injury
of the SSN. An anterior approach to this transfer does not allow for visualization
of the nerve at the scapular notch which is a disadvantage when compared with a posterior
approach to the SSN.
Methods All patients of the senior author (S.F.) with traumatic brachial plexus injuries
undergoing spinal accessory nerve to SSN transfer via the posterior approach were
analyzed.
Results Of the 58 patients, 11 (19.0%) demonstrated abnormal findings at the notch. In two
of these 11 patients (18.2%), reconstruction was abandoned due to severe injury of
the nerve. There was a higher rate of clavicular fractures in patients with SSN injuries
at the notch, compared with no SSN injury at the notch (63.6 vs. 12.8%).
Conclusion The dSAN to SSN transfer is a reliable reconstruction for restoration of shoulder
external rotation and abduction. There is a high proportion of injuries to the nerve
at the notch, which can be best appreciated from a posterior approach. The authors,
therefore, advocate a posterior approach for this nerve transfer.
Keywords
suprascapular nerve - brachial plexus - notch
