Shoulder Function Reconstruction in Brachial Plexus Birth Injury: Anterior Shoulder Release and Spinal Accessory to Suprascapular Nerve Transfer.

PURPOSE

This study evaluated the efficacy of the spinal accessory to suprascapular nerve transfer accompanied by anterior shoulder release in restoring shoulder external rotation and abduction in patients with brachial plexus birth injury.

METHODS

A cohort of 41 children with brachial plexus birth injury and shoulder internal rotation contractures underwent surgical intervention. The procedure involved an anterior shoulder release encompassing subscapularis tenotomy, capsulotomy and division of the coracohumeral ligament, and transfer of the spinal accessory nerve to the suprascapular nerve. At an average of 31 months after surgery, we conducted postoperative evaluations of shoulder abduction and external rotation range of motion and compared those with the preoperative status of the patients.

RESULTS

From the initial cohort, 26 patients with sufficient follow-up were included in the analysis. The average age at surgery was 15 months. Before surgery, patients demonstrated an average active abduction of 36° and an internal rotation contracture of 64°, measured with the elbow flexed, the shoulder adducted, and using the thorax as the 0° reference point. After surgery, there were significant improvements, with average external rotation increasing to 116° and abduction to 94°. One patient failed to recover external rotation, but most patients showed improved function without the recurrence of internal rotation contractures.

CONCLUSIONS

Spinal accessory to suprascapular nerve transfer before or after 6 months of age combined with subscapularis tenotomy significantly improves shoulder external rotation and abduction in children with brachial plexus birth injury and internal rotation contractures.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.