Reconstruction of Shoulder Abduction and External Rotation in Obstetrical Brachial Plexus Palsy Patients

Abstract

Stability of the shoulder joint and restoration of abduction are important following obstetrical brachial plexus paralysis, as more distal functions depend on having a stable and functioning shoulder. Both deltoid and supraspinatus muscles are active and play a significant role during arm abduction. Along with the suprascapular nerve reinnervation, it is our policy to also neurotize the axillary nerve. The purpose of this report is to present our experience of suprascapular nerve reconstruction in cases of obstetrical brachial plexus palsy. Our overall results were good or excellent in 96% of the patients for the supraspinatus muscle and 75% of the patients for the infraspinatus muscle. Suprascapular nerve neurotization from distal spinal accessory nerve produced similar results to those obtained after reconstruction from the C5 proximal stump. Early surgery (at less than 6 months of age) yielded significantly better results than late surgery (at more than 6 months of age). When microsurgical reconstruction of the brachial plexus is performed before the age of 3 months, it is unlikely for the patient to need a secondary procedure for correction of results obtained after nerve repair.