American Society for Peripheral Nerve

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Transfer of the Rhomboid Nerve to the Suprascapular Nerve in Partial Brachial Plexus Palsies: a New Nerve Transfer
Jean-Noel Goubier, MD, PhD; Teboul Frédéric, MD
Institute for Nerve and Brachial Plexus Surgery, Paris, France

Recovery of shoulder function is a real challenge in partial brachial plexus palsies. Currently in C5 C6 root injuries, transfer of the long head of the triceps branch is proposed to reanimate the deltoid muscle. Spinal accessory nerve transfer is usual to reanimate the suprascapular nerve. We have proposed an alternative technique using the nerve of the rhomboid muscles transferred to the suprascapular nerve.
Two patients, 27 and 33 year-old males, with a C5 C6 root rupture with shoulder and elbow flexion palsy underwent surgery 7 months after injury. The rhomboid nerve was transferred to the suprascapular nerve and the long head of the triceps branch to the axillary nerve for shoulder reanimation. A double transfer of fascicles was performed, from the ulnar and median nerve to the biceps branch and the brachialis branch, respectively, for elbow flexion. At the 14-month follow-up, elbow flexion was rated at M4. Shoulder elevation was 85 degrees and rated M4, and external rotation was 80 degrees and rated M4. No complications were noted.
In an anatomical study previously published, we showed that the transfer of the rhomboid nerve to the suprascapular nerve is technically possible. The rhomboid nerve comes from the C5, and sometimes C3 and C4 roots, therefore, it may be used in case of C5 rupture. These two first cases prove that this transfer is clinically possible and gives some positive results. Obviously, these results should be confirmed in a larger series with longer follow-up. This transfer could be an alternative to the spinal accessory nerve transfer to the suprascapular nerve, especially in cases of supraclavicular scarring, spinal accessory nerve injuries, or in order to use the spinal accessory nerve for another target.


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