Treatment of Glenohumeral Dysplasia in Brachial Plexus Birth Injury with an End-to-Side Spinal Accessory Nerve to Suprascapular Nerve Transfer
Nathan Khabyeh-Hasbani, BA, Md Sibat Noor, MD and Steven M Koehler, MD, Montefiore Medical Center, Bronx, NY
Brachial plexus birth injury (BPBI) is a common birth injury that has a variable incidence rate worldwide. The spectrum of disease prognosis ranges from spontaneous recovery to lifelong debilitating disability, particularly of the shoulder joint. Surgery is the mainstay treatment for patients with BPBI to prevent shoulder deformity in the form of glenohumeral dysplasia (GHD), however, there is no clear-cut criteria for applying various surgical interventions. The surgical procedures can range from nerve grafting to nerve transfer or tendon transfer for restoring shoulder function. Herein, we report six cases of infants who underwent end-to-side spinal accessory nerve to suprascapular nerve transfers for treatment of GHD due to BPBI.
Six infants who underwent end-to-side nerve transfer of the spinal accessory nerve to the suprascapular nerve for the treatment of GHD due to BPBI were enrolled. Preoperative diagnosis, pre- and postoperative Active Motion Scale (AMS) scores, pre- and postoperative serial ultrasounds, surgical exploration findings, surgical techniques, postoperative complications, postoperative rehabilitation, and postoperative range of motion results were included.
The age range for the six subjects was 4 months to 7 months. All patients presented with a history of BPBI and subsequent GHD. Each patient had participated in therapy since birth. Preoperative ultrasound of the shoulder joint demonstrated GHD in all cases. The patients underwent brachial plexus exploration, which revealed upper trunk neuromas. External rotation was not observed in any patient with 0.5mA or 2.0mA stimulation. Therefore, all patients were indicated for an end-to-side transfer of the spinal accessory nerve to the suprascapular nerve. No patients experienced complications. Postoperative therapy was continued, but no bracing was performed. Each patient was followed up for a minimum of 6 months post surgery or until patients demonstrated full shoulder range of motion, shoulder AMS improvement, and ultrasound revealed resolution of GHD.
We report six cases of patients with BPBI and concurrent GHD who were successfully treated with end-to-side spinal accessory to suprascapular nerve transfers. This is a novel procedure that addresses gray areas in which patients may not be indicated for a tendon transfer nor an end-to-end nerve transfer.
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Intraoperative picture of the spinal accessory to suprascapular end to side transfer.png
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