Influence of surgical approach in the outcome of double nerve transfer for shoulder function in the upper brachial plexus injuries

Purpose

This study compares the anterior deltopectoral and posterior approaches described for shoulder function outcomes in upper brachial plexus injuries.

Methods

A prospective study divided the upper brachial plexus injuries into two groups based on the surgical approach (anterior deltopectoral and posterior) in 46 patients. The age at the time of injury, delay in surgery, operating time, and postoperative motor recovery time was noted. The functional outcome assessed by the Medical Research Council (MRC grade) and range of shoulder movements were compared and statistically analyzed between these two groups.

Results

The age at the time of injury, delay in surgery, surgical approach, motor recovery time had no significant impact on the functional outcome (p > 0.05). The double nerve transfer for the shoulder achieved M4 and M5 grade abduction and a good to an excellent range of motion in both groups. However, there were no differences in the postoperative MRC grading and shoulder range of movements between these two groups. But the operating time was significantly reduced in the anterior approach (P < 0.05) for C5,6 brachial plexus injuries.

Conclusions

The anterior deltopectoral and posterior approaches efficiently restore shoulder abduction and range of movements in upper brachial plexus injuries. Targeting the second segment of the axillary nerve (anterior and posterior branch), access to multiple donors, and reduced operating time are the advantages of the deltopectoral approach.

Level of evidence

IV