Abstract
Brachial plexus injuries usually result in significant upper limb disabilities and shoulder joint instability. Primary nerve reconstruction procedures are more effective if performed within six months from the injury. Secondary procedures, including muscle transfers, are usually indicated for delayed presentation (>6 months) or when the outcomes of primary procedures are unsatisfactory.A comprehensive systematic search of the MEDLINE, EMBASE, AMED, PubMed, and Cochrane databases was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data, including demographic information, time to surgery, the extent of brachial plexus injury, surgical techniques, follow-up duration, and functional outcomes were collected and tabulated. Meta-analysis was conducted using Review Manager (RevMan) 5.4 software ([Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Seven studies were eligible to be included in this review, with a total of 218 patients. The average patient age was 28.39 ± 3 years, with a mean time to surgery of 29.87 ± 18 months. Forty-six (46) patients (21.10%) were treated as delayed presentation and 172 patients (78.89%) had muscle transfer performed as a secondary procedure. The mean time at follow-up was 18.86 ± 13.5 months. Upper trapezius muscle transfer was the most common transferred muscle (100%) either in isolation (n=159, 72.93%) or in combination with lower trapezius transfer (n=59, 27.06%). The mean preoperative and postoperative shoulder abduction were 12.22 ± 10.09 degrees and 58.36 ± 32.33 degrees, respectively (p < 0.05). Meta-analysis shows a statistically significant difference (CI at 95%, p<0.05) favoring postoperative shoulder abduction.Muscle transfers especially upper trapezius transfer could be a satisfactory secondary procedure to restore shoulder abduction and enhance shoulder joint stability.
Highlights
BackgroundThe brachial plexus is a neural network that originates from the lower four cervical and first thoracic nerve roots, providing motor and sensory innervation to the upper limb [1]
The search strategy included a set of terms for "muscle transfer", "shoulder abduction", and "brachial plexus injury", which were connected by the Boolean operator
Published articles between 1940 and up to May 2020, which met the following criteria, were included: 1. Randomized controlled studies, controlled trials, or cohort studies reporting the outcomes of muscle transfers to restore shoulder abduction for brachial plexus injuries in the adult population
Summary
The brachial plexus is a neural network that originates from the lower four cervical and first thoracic nerve roots, providing motor and sensory innervation to the upper limb [1]. Adult traumatic brachial plexus injuries (ATBPI) usually result in significant upper limb motor and sensory dysfunction. These injuries result from various modes of closed trauma, such as nerve traction or rupture, and, less commonly, from open lacerations and gunshots [2]. Millesi classified brachial plexus injuries into preganglionic, postganglionic, trunk, or cord injuries [4]. Another classification describes the injury relative to the clavicle, supra-clavicular, retro-clavicular, and infra-clavicular [3]. Male patients aged between 15 and 25 years old are the most affected cohort [6]
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