The Utilization of Nerve Transfer for Reestablishing Shoulder Function in the Setting of Acute Flaccid Myelitis: A Single Institution Review
Taylor Paziuk, MD1; Scott H Kozin, MD2; Madeline Tadley, MD3; Dan A Zlotolow, MD2; Aversano Michael, MD4
1Rorthman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA; 2Shriners Hospital for Children Philadelphia, Philadelphia, PA; 3Rothman Orthopaedic Institute at Thomas Jefferson, Philadelphia, PA; 4Shriners, Philadelphia, PA
Acute Flaccid Myelitis (AFM) is rare and devastating disease of young children. Although the etiology of this disease remains unknown, the typical presentation involves acute onset flaccid paralysis in one or more extremities with a nonspecific prodrome that may resemble a self-limited upper respiratory tract infection. Treatment for this illness is largely supportive and long-term functional outcomes demonstrate that muscle group recovery plateaus around 6 to 9 months and is often incomplete, leaving patients with considerable long-term deficits. The purpose of this study was to evaluate the efficacy of different nerve transfers for the purpose of restoring shoulder function in this cohort of patients.
A retrospective review of all patients diagnosed with AFM at a single institution who underwent nerve transfers for the purpose of restoring shoulder function. Shoulder function was evaluated pre and postoperatively via the active movement scale (AMS) score. Children at a minimum of 6 months after initial diagnosis with plateaued shoulder AMS scores of 4 or less were indicated for nerve transfers if a donor was identified.
11 patients were identified who met inclusion criteria. The average age at symptom onset was just over 40 months and the mean time from symptom onset to surgery was 12 months. Average postoperative follow up with 19 months. Mean AMS score at follow up for shoulder external rotation and abduction, regardless of which nerve transfers were performed, was 4.6 (range: 0-7) and 2.8 (range: 0-7), respectively. The most common transfers were spinal accessory nerve to suprascapular nerve (n=8) and intercostal nerves x3 to axillary nerve (n=5). Patients who received a radial nerve to axillary nerve transfer, regardless of if they received another nerve transfer, had the best functional returns, with mean AMS score of 6.5 in both external rotation and abduction at follow up.
Nerve transfer procedures may help restore shoulder function in the setting of motor deficits associated with AFM. Combination procedures that involve a radial nerve to axillary nerve transfer may provide the best functional results.
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