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Outcomes of Nerve Reconstruction in Axillary Nerve Injuries With or Without Radial Nerve Involvement: Case Series and Lessons Learned
Dun Wei Huang, MD
1,2,3, Tommy Nai-Jen Chang, MD
4, Johnny Chuieng-Yi Lu, MD, MSCI
5, Chung-Yu Lai, PhD
6; David Chwei-Chin Chuang, MD
2(1)Tri-Service General Hospital, National Defense Medical University, Taipei, Taipei, Taiwan, (2)WanFang Hospital, Taipei Medical University, Taipei, Taipei, Taiwan, (3)National Defense Medical University, Taipei, Taipei, Taiwan, (4)Chang Gung Memorial Hospital, Taoyuan, Taiwan, (5)Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan, (6)Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical University, Taipei, Taipei, Taiwan
Introduction:
Shoulder function relies on a complex interplay of multiple muscles, making its restoration after nerve injury a significant clinical challenge. Outcomes of shoulder reanimation in brachial plexus injury (BPI) are often suboptimal, particularly when associated with skeletal or tendinous injuries around the shoulder. Tendon transfers and arthrodesis play a limited role and are considered secondary procedures in improving shoulder external rotation or adding stability to the glenohumeral joint. Although radial nerve reconstruction has shown excellent outcomes for elbow function in BPI, the impact of radial nerve involvement on axillary nerve reconstruction remains underreported. This study aims to evaluate the outcomes of nerve reconstruction in axillary nerve injuries, with or without radial nerve involvement, and to investigate how concomitant radial nerve injury influences axillary nerve reconstruction.
Materials & Methods:
We retrospectively reviewed data from a single-center database (2010-2022), including patients with axillary nerve injuries, with or without radial nerve involvement. Patients were categorized into four groups for outcome comparison: (1) interposition nerve graft for isolated axillary nerve, (2) distal radial-to-axillary nerve transfer, (3) intraplexus nerve graft for both axillary and radial nerves, and (4) neurolysis only. Outcomes were assessed based on degree of shoulder abduction movement and muscle strength (BMRC scale).
Results:
A total of 16 patients were included, with a mean age of 38 years (range from 18 to 68). The average interval between injury and operation was five months. An optimal result for deltoid muscle recovery is defined as muscle strength (MRC)?M3, indicating visible deltoid muscle movement with shoulder abduction degree ?90°. 75% (12/16) patients who underwent nerve reconstruction showed improved clinical result. Subgroup analysis revealed favorable outcomes in all 4 patients who received interposition nerve grafts for isolated axillary nerve injuries, 67% (4/6) of those who underwent distal radial-to-axillary nerve transfers, and 80% (4/5) of those treated with proximal nerve grafts from cord or division levels of the brachial plexus for both axillary and radial nerve. In contrast, the patient treated with neurolysis alone had a poor outcome.
Conclusions:
Nerve reconstruction is effective in restoring shoulder function in axillary nerve injuries, with or without radial nerve involvement. The intraplexus nerve approach allows simultaneous reconstruction of both nerves and enables more precise intraoperative assessment of radial nerve injury severity, which may help estimate the extent of axillary nerve damage, including the required graft length and potential functional outcomes.
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