Spinal Accessory Nerve to Suprascapular Nerve Transfer by Dorsal Approach for Shoulder Reanimation in Cases of Brachial Plexus Injuries: Surgical Technique

Abstract

Distal nerve transfers are frequently used for the treatment of patients having brachial plexus injuries. Spinal accessory nerve to suprascapular nerve transfer by dorsal approach is advantageous since it brings the site of neurotization closer to the neuromuscular end plate and minimizes donor muscle weakness. This surgery is found to be challenging owing to the small and deep operative field. In this article, the authors describe the surgical technique for this procedure.

Keywords

Brachial plexus injury - suprascapular nerve - spinal accessory nerve - nerve transfer - shoulder reanimation

• References

• 1 Guan SB, Hou CL, Chen DS, Gu YD. Restoration of shoulder abduction by transfer of the spinal accessory nerve to suprascapular nerve through dorsal approach: a clinical study. Chin Med J (Engl) 2006; 119 (09) 707-712
• 2 Bhandari PS, Sadhotra LP, Bhargava P, Singh M. et al. Dorsal approach in spinal accessory to suprascapular nerve transfer in brachial plexus injuries: technique details. Ind J Neurotr 2010; 7 (01) 71-74
• 3 Bhandari PS, Deb P. Dorsal approach in transfer of the distal spinal accessory nerve into the suprascapular nerve: histomorphometric analysis and clinical results in 14 cases of upper brachial plexus injuries. J Hand Surg Am 2011; 36 (07) 1182-1190
• 4 Bhandari PS, Deb P. Posterior approach for both spinal accessory nerve to suprascapular nerve and triceps branch to axillary nerve for upper plexus injuries. J Hand Surg Am 2013; 38 (01) 168-172
• 5 Puri VA, Mahendru S, Rana RE. Use of henna as a skin marker. J Plast Reconstr Aesthet Surg 2006; 59 (10) 1123-1124
• 6 Cabbad NC, Nuland KS, Pothula A. Intraoperative fluoroscopic imaging for suprascapular nerve localization during spinal accessory nerve to suprascapular nerve transfer. J Hand Surg Am 2017; 42 (08) 668.e1-668.e5
• 7 Ticker JB, Djurasovic M, Strauch RJ. et al. The incidence of ganglion cysts and other variations in anatomy along the course of the suprascapular nerve. J Shoulder Elbow Surg 1998; 7 (05) 472-478
• 8 Alon M, Weiss S, Fishel B, Dekel S. Bilateral suprascapular nerve entrapment syndrome due to an anomalous transverse scapular ligament. Clin Orthop Relat Res 1988; (234) 31-33
• 9 Polguj M, Sibiński M, Grzegorzewski A, Waszczykowski M, Majos A, Topol M. Morphological and radiological study of ossified superior transverse scapular ligament as potential risk factor of suprascapular nerve entrapment. BioMed Res Int 2014; 2014: 613601
• 10 Colbert SH, Mackinnon S. Posterior approach for double nerve transfer for restoration of shoulder function in upper brachial plexus palsy. Hand (N Y) 2006; 1 (02) 71-77
• 11 Merrell GA, Barrie KA, Katz DL, Wolfe SW. Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature. J Hand Surg Am 2001; 26 (02) 303-314
• 12 Chuang DC, Lee GW, Hashem F, Wei FC. Restoration of shoulder abduction by nerve transfer in avulsed brachial plexus injury: evaluation of 99 patients with various nerve transfers. Plast Reconstr Surg 1995; 96 (01) 122-128
• 13 Tahir H, Osama M, Beg MSA, Ahmed M. Comparison of anterior vs. dorsal approach for spinal accessory to suprascapular nerve transfer in patients with a brachial plexus injury and its outcome on shoulder function. Cureus 2022; 14 (07) e26543
• 14 Jimulia DT, Duraku LS, Parekh JN, George S, Chaudhry T, Power DM. The clinical outcomes of spinal accessory to suprascapular nerve transfer through a posterior approach. Hand (N Y) 2023; 0 (00) 15 589447231199797