Abstract
Introduction Brachial plexus injuries are severe life-altering injuries. The surgical method to
restore shoulder abduction in adult upper brachial plexus injuries involves the usage
of nerve grafts and nerve transfers targeting the suprascapular and/or the axillary
nerve. When the primary nerve surgery has been unsuccessful or recovery has been incomplete
or with a late presentation, muscle transfer procedures are needed to provide or improve
shoulder abduction. Levator scapulae to supraspinatus is a transfer to improve shoulder
abduction in posttraumatic brachial plexus injuries.
Material and Methods The study included 13 patients with the age ranging from 17 to 47 years with a mean
age of 30 years. All these patients had preop shoulder abduction of Medical Research
Council (MRC) grade ≤3. All had a minimum of MRC grade 4 of active elbow flexion.
Eleven patients had primary surgery. Only patients with a minimum of 1 year postoperative
follow-up were included. All 13 patients underwent levator scapulae transfer only.
Results All patients had a stable shoulder postoperatively. The average increase in active
shoulder abduction was from 6.15°(median: 0°) preoperatively to 61.92°(median: 60°),
with an average gain in shoulder abduction of 49.61°(median: 50°).
Conclusions Transfer of levator scapulae tendon to the supraspinatus is an option to improve
shoulder abduction in posttraumatic brachial plexus. In conditions where supraspinatus
alone is not functioning, levator scapulae is the best available transfer, considering
its strength and maintaining the form of the shoulder unlike trapezius transfer. In
patients with previous surgery where supraspinatus has recovered partially but not
functionally significant, this tendon transfer can be considered for the augmentation
of the existing shoulder abduction.
Keywords
brachial plexus injuries - levator scapulae - supraspinatus
