Extraplexal Nerve Transfers to Shoulder and Elbow in High Grade Obstetric Brachial Plexus Palsy

Abstract

Background: There is a paucity of reports on the use of extraplexal nerve transfers in the management of severe grades of obstetrical brachial plexus injury. The present study is aimed at evaluation of results of spinal accessory and intercostal nerve transfer in restoration of shoulder abduction and elbow flexion in obstetric palsy.

Material and methods: Twenty patients with severe grades of obstetric palsy, who had avulsion of 4 or more spinal roots, underwent nerve transfer between spinal accessory nerve to suprascapular nerve and the three intercostal nerves to musculocutaneous nerve. Any available nerve root was directed to the median nerve or inferior trunk with intervening sural nerve grafts.The age at surgery ranged from 3 to 23 months, with a mean of 10 months.

Results: The children were followed up for 24 to 98 months, with an average of 40 months. No complications, per or postoperative, were noticed on harvesting of three intercostals nerves. Active abduction was restored in 18 patients with abduction strength of M4 in 4, M3 in 10 and M2 in 4. Eight patients had useful recovery in external rotation. Seventeen children restored active elbow flexion with biceps strength of M4 in 5, M3 in 13 and M2 in 2. Functional results were better when surgery was performed before the age of 6 months.

Conclusion: Use of spinal accessory and intercostal nerves is a safe and an effective procedure in the rehabilitation of patients with severe grade of obstetric brachial plexus palsy