Nerve Transfers for partial brachial plexus palsy in adults: a series of 80 patients
Seance of wednesday 20 november 2024 (Communications libres)
DOI number : 10.26299/2z3k-t930/emem.2024.31.03
Abstract
Partial brachial plexus palsies in adults account for about twenty five percent of all traumatic brachial plexus palsies in adults. In most patients, the shoulder and elbow are paralyzed, more rarely paralysis of the hand only. Our series consists of 80 patients with an average age of 35 years, including 9 women and 71 men. 51 patients had a total elbow flexion palsy, 31 patients had a shoulder palsy, 6 patients had flexion or extension palsy of the fingers.
All patients underwent surgery with nerve transfers: a transfer of the long head of the triceps nerve to the anterior branch of the axillary nerve in 31 patients and to the teres minor nerve in 26 patients, a transfer of the rhomboid nerve to the suprascapular nerve in 5 patients for shoulder external rotation reanimation. Transfer of an ulnar nerve fascicle and median nerve to the biceps and anterior brachialis nerves for reanimation of elbow flexion in 51 patients, transfer of an ulnar nerve fascicle to the long triceps nerve for elbow extension reanimation in 4 patients, an extensor carpi radialis brevis nerve transfer to the anterior Interosseus nerve for finger flexion reanimation in two patients and a supinator nerve transfer to the posterior interosseous nerve for finger extension reanimation in 2 patients. 48 patients recovered elbow flexion at M4, 2 patients at M3 and one patient at M2; 17 patients recovered elevation and abduction of the shoulder at M4, 9 patients at M3, and less than M3 in 5 patients; 6 patients recovered an external rotation of the shoulder at M4, 18 patients at M3, 7 patients an external rotation less than M3. Four patients recovered elbow extension at M4 and 2 patients recovered active finger flexion and 2 patients active finger extension.
Our results are globally comparable to those of the literature. The proportion of results rated at M4 according to the BMC remains satisfactory, particularly for the reanimation of elbow flexion, making nerve transfer a treatment of choice for partial paralysis. This is why nerve grafting, from non-avulsed roots, is no longer an option for us for the reanimation of elbow flexion in this type of lesion.
Goubier JN, F. Teboul, Echalier C
All patients underwent surgery with nerve transfers: a transfer of the long head of the triceps nerve to the anterior branch of the axillary nerve in 31 patients and to the teres minor nerve in 26 patients, a transfer of the rhomboid nerve to the suprascapular nerve in 5 patients for shoulder external rotation reanimation. Transfer of an ulnar nerve fascicle and median nerve to the biceps and anterior brachialis nerves for reanimation of elbow flexion in 51 patients, transfer of an ulnar nerve fascicle to the long triceps nerve for elbow extension reanimation in 4 patients, an extensor carpi radialis brevis nerve transfer to the anterior Interosseus nerve for finger flexion reanimation in two patients and a supinator nerve transfer to the posterior interosseous nerve for finger extension reanimation in 2 patients. 48 patients recovered elbow flexion at M4, 2 patients at M3 and one patient at M2; 17 patients recovered elevation and abduction of the shoulder at M4, 9 patients at M3, and less than M3 in 5 patients; 6 patients recovered an external rotation of the shoulder at M4, 18 patients at M3, 7 patients an external rotation less than M3. Four patients recovered elbow extension at M4 and 2 patients recovered active finger flexion and 2 patients active finger extension.
Our results are globally comparable to those of the literature. The proportion of results rated at M4 according to the BMC remains satisfactory, particularly for the reanimation of elbow flexion, making nerve transfer a treatment of choice for partial paralysis. This is why nerve grafting, from non-avulsed roots, is no longer an option for us for the reanimation of elbow flexion in this type of lesion.
Goubier JN, F. Teboul, Echalier C