Transfer of combined nerve fascicles for reconstruction of shoulder abduction and elbow flexion after C5-C6 avulsion of the brachial plexus

Objective To explore the clinical outcomes of transfer of combined nerve fascicles to reconstruct the shoulder abduction and elbow flexion lost after C5 or C5-C6 avulsion of the brachial plexus.Methods Between January 2007 and December 2010,21 patients with upper avulsion of the brachial plexus were treated in our department.They were aged from 17 to 58 years,with an average of 31.5 years.There were 6 cases of C5 root avulsion and 15 cases of C5-C6 root avulsion.The time interval between the injury and the operation ranged from 3 to 11 months (average,5.1 months).All the 21 patients lost abduction and external rotation of the shoulder and 15 of them lost elbow flexion in addition.All the patients underwent transfer of the spinal accessory nerve to repair the suprascapular nerve,transfer of the nerve to the long head of the triceps to repair the anterior branch of the axillary nerve,and partial transfer of the ulnar nerve fascicle to repair the biceps motnr branch (in 15 cases). Results Two cases were lost to the follow-up and the other 19 patients obtained follow-ups for 15 to 30 months,with an average of 19.6 months.At the last follow-up,the shoulder abduction was recovered to a range from 40° to 180° (average,92°); the active external rotation of the shoulder was recovered to a range from 60° to 120° (average,91°); the muscle strength of the supraspinatus and the infraspinatus was recovered to M4 in 10 patients,to M3 in 7 patients and to M2 in 2 patients; the muscle strength of the deltoid was recovered to M4 in 11 patients,to M3 in 6 patients and to M2 in 2 patients.Of the 14 patients without the function of elbow flexion who had been followed up,12 had active elbow flexion ＞ 90° and 2 had active elbow flexion between 60° and 90°.According to the Narakas' s functional evaluation system for the brachial plexus,the shoulder function was rated as excellent in 9 cases,as good in 7 cases,and as poor in 3 cases,with a good to excellent rate of 84.2％.The elbow function was excellent in 8 cases,good in 4 cases and ponr in 2 cases,with a good to excellent rate of 85.7％. Conclusion Transfer of combined nerve fascicles with functional similarity to early reconstruct the shoulder abduction and elbow flexion following C5-C6 root avulsion of the brachial plexus is feasible and effective,because it results in limited operative invasion,and quick and sound functional recovery of the limb affected. Key words: Nerve transfer; Reconstructive surgical procedures; Brachial plexus neuropathies; Shoulder joint; Elbow joint