In total brachial plexus injury when ipsilateral spinal accessory nerve is also traumatized we offer the use of contralateral SAN as an additional option in the reinnervation of suprascapular nerve. Technique- Through a transverse incision over the spine of scapula, the distal part of suprascapular nerve (SSN) is dissected up to the suprascapular notch. SSN…
DetailsIntroduction The incidence of obstetric brachial plexus palsy (OBPP) ranges globally from 0.5 to 2 per 1000 births with the higher numbers in under developed countries. A majority of them progress to complete recovery, other may improve slowly but incompletely. The rate of complete, spontaneous recovery varies in the literature from 30 % to 95…
DetailsTraditionally, spinal accessory to suprascapular nerve transfers have been performed by anterior approaches. However transection of spinal accessory nerve at proximal level leads to denervation of upper trapezius, which plays an important role in shoulder function. Distal transection spares the important branches to trapezius and preserves its function of shoulder stabilization and elevation. Dorsal/ Posterior…
DetailsBackground-Traumatic brachial plexus injury is a devastating condition resulting mainly from motor cycle accidents and primarily affecting the young adults. In the past there was a pessimistic attitude in the management of these injuries. However in last two decades with the introduction of microsurgical techniques and advancements in imaging modalities, these injuries are being explored…
DetailsA brachial plexus injury results from the injury to the network of the nerves and manifests as impairment of motor and sensory functions of the involved upper limb. Brachial plexus injury is usually sustained in high speed motor bike accidents. These injuries occur in approximately 4.2% of motor cycle accidents.1 Other less common modes of…
DetailsA patient with brachial plexus injury is likely to have sustained other concomitant injuries; head injury, fractures in the cervical spine, clavicle, scapula, and extremities, chest and abdominal trauma and vascular injuries. The neurological examination should determine the specific motor and sensory deficits. The British Medical Research Council grading system is used to measure the…
DetailsTiming of Repair The commonly seen closed injuries are initially managed conservatively. Some of them are neuropraxic injuries and recover in few weeks time. Other injuries should be observed up to 10 to 12 weeks for spontaneous recovery. During this period passive range of joints is maintained. After one month of injury an electromyography and…
DetailsC5 – C6 and upper truncal injury An upper truncal injury with intact nerve roots is amenable to nerve graft repair. In C5-C6 root avulsion injury nerve transfers offer far superior results over tendon/ muscle transfers or shoulder arthrodesis . Nerve transfer between the distal spinal accessory nerve and the suprascapular nerve through the posterior…
DetailsIn C5,C6 root avulsions the proximal root stumps are not available for grafting, hence repair is based on nerve transfer or neurotization. Restoration of elbow flexion takes priority in functional reconstruction, followed by shoulder abduction and external rotation. Reinnervation of musculocutaneous nerve has been achieved with transfer of a variety of donor nerves; the spinal…
DetailsSpinal accessory nerve to suprascapular nerve transfer Patient is placed in the lateral position with head of the operating table raised by 40 degrees . An incision is made parallel to the spine of scapula. The trapezius muscle is elevated from the scapular spine and the space between the trapezius and the supraspinatus muscles is…
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