Abstract
Objectives The purpose of this study was to report the functional outcomes of phrenic nerve
transfer (PNT) to suprascapular nerve (SSN) for shoulder reconstruction in brachial
plexus injury (BPI) patients with total and C5–8 palsies, and its pulmonary complications.
Methods Forty-four out of 127 BPI patients with total and C5–8 palsies who underwent PNT
to SSN for shoulder reconstruction were evaluated for functional outcomes in comparison
with other types of nerve transfers. Their pulmonary function was analyzed using vital
capacity in the percentage of predicted value and Hugh-Jones (HJ) breathless classification.
The predisposing factors to develop pulmonary complications in those patients were
examined as well.
Results PNT to SSN provided a better shoulder range of motion significantly as compared with
nerve transfer from C5 root and contralateral C7. The results between PNT and spinal
accessory nerve transfer to SSN were comparable in all directions of shoulder motions.
There were no significant respiratory symptoms in majority of the patients including
six patients who were classified into grade 2 HJ breathlessness grading. Two predisposing
factors for poorer pulmonary performance were identified, which were age and body
mass index, with cut-off values of younger than 32 years old and less than 23, respectively.
Conclusions PNT to SSN can be a reliable reconstructive procedure in restoration of shoulder
function in BPI patients with total or C5–8 palsy. The postoperative pulmonary complications
can be prevented with vigilant patient selection.
Keywords
brachial plexus injury - phrenic nerve transfer - suprascapular nerve
