The evolution of nerve transfer restoration of shoulder function

Abstract

Loss of shoulder abduction and external rotation reduces the working space for the upper limb and hand. Paralysis may follow C5 nerve root avulsion, upper trunk rupture or isolated injuries to the suprascapular and axillary nerves. Motor nerve transfer surgery involves a direct transfer of an expendable motor branch from a muscle in the vicinity of the paralyzed muscle and direct transfer with microsurgical end-to-end coaptation to the nerve to the denervated muscle close to its motor point. Reinnervation is rapid and robust. The technique was described for the restoration of deltoid function more than a century ago but was not adopted into wide spread use until the past two decades. This article explores the various options of nerve transfer surgery to restore function of shoulder function and reviews the evidence. Refinements in the procedure have resulted with the current algorithm for management, which will be described with its rationale and a review of clinical outcomes.