Nerve Transfers Restore Shoulder Function in Most Brachial Plexus Cases

Published July 2019 | Journal of Hand Surgery

A study of 73 children who received spinal accessory nerve-to-suprascapular nerve transfer (SAN-SSN) at Cincinnati Children’s for brachial plexus birth injuries reveals that most patients recovered enough shoulder function that they did not need further procedures. Brachial plexus birth injuries affect approximately 1.5 children per 1,000 live births in the United States and can lead to permanent neurological deficits in up to 30% of affected children.

In this study, first author David Segal, MD, and senior author Kevin Little, MD, reviewed outcomes at one year after patients received an SAN-SSN procedure. They also extended the review to three years post-surgery for many of those studied.

They report that 76.7% of the patients receiving SAN-SSN recovered enough function to prevent tendon transfers and corrective osteotomies. Forty-three patients (58.9%) obtained functional shoulder motion of at least one of three planes (abduction/flexion/external rotation).

The rate of patients who achieved functional abduction motion grew from 12.3% to 39.7%; functional forward flexion motion improved from 12.3% to 41.1%, and external rotation motion improved the most, from 2.7% to 39.7%.

The team was surprised to see the favorable forward flexion outcomes because the transferred nerve does not directly control this motion. “This significant improvement may underscore how rotator cuff strength, augmented by the SAN-SSN transfer, plays a role in all shoulder movements,” Little says.

The amount of regained motion also improved across time for most patients. Among the 47 patients who were followed for three years, those obtaining at least one functional AMS score increased to 66%.

“With this evidence of reduced need for more-extensive secondary procedures, SAN-SSN may become the first line procedure for shoulder reconstruction in brachial plexus birth injuries,” Little says.