American Society for Peripheral Nerve

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Does Dual Nerve Transfer for Shoulder Abduction Produce Better Results in Total Brachial Plexus Injury?
Kevin T Rezzadeh, BA, New York University School of Medicine, New York, NY, Megan Donnelly, BS, NYU School of Medicine, New York, NY, David Daar, MD, New York University Langone Health, New York, NY and Jacques Hacquebord, MD, NYU Langone Medical Center, New York, NY


While dual nerve transfer has demonstrated favorable outcomes for shoulder abduction in UBP injury patients, specifically with the branch of the triceps to axillary nerve (AXN) transfer being used as a second nerve transfer, the use of intercostal nerve as a donor nerve for axillary neurotization is less well established. We hypothesize that TBP injury patients with 2NT will have similar postoperative results than patients with 1NT, because the ICN may be an unreliable nerve donor for axillary neurotization.


A systematic review of the literature was conducted according to PRISMA guidelines. Inclusion criteria were studies reporting outcomes on patients undergoing spinal accessory nerve (SAN) to suprascapular nerve (SSN) transfer. Patients were excluded for the following reasons: age under 18, brachial plexus injury other than total brachial plexus injury, nerve transfer for reanimation under of the shoulder other than SAN to SSN and/or AXN neurotization, and less than 12 months of follow-up postoperatively. The 1NT group had SAN to SSN, the 2NT group had SAN to SSN transfer and ICN to AXN transfer. Pooled analysis was performed, and primary outcomes were Medical Research Council (MRC) score and range of motion (ROM) for shoulder abduction.


Fifty-eight patients from six studies were included. Age, sex, and injury to surgery interval were well matched with the 1NT and 2NT groups. The 2NT group has significantly higher abduction range (59.6 vs 85.6, p<0.001), mean MRC scores (3.5 vs 2.2, p=0.003), and percentage of patients that achieved MRC scores greater than or equal to 4 (28.2% vs 8.3, p<0.001).


Dual nerve transfer utilizing SAN to SSN transfer and ICN to AXN transfer produces superior shoulder abduction outcomes in TBP patients than single nerve transfer using SAN to SSN transfer alone. The ICN may be a valuable donor nerve for AXN neurotization in patients with brachial plexus injury involving the upper trunk.

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