Transfer of Triceps Motor Branches of the Radial Nerve to the Axillary Nerve with or without other Nerve Transfers Provides Antigravity Shoulder Abduction in Pediatric Brachial Plexus Injury

Abstract

Restoration of shoulder abduction following injury to the brachial plexus is sometimes difficult to achieve in obstetrical brachial plexus palsy and traumatic brachial plexus palsy. Nerve transfers are a recognized treatment option for patients with traumatic brachial plexus injuries [5]. To maximize shoulder function, notably shoulder abduction and external rotation, simultaneous reconstruction of the suprascapular and axillary nerves is often advocated [6, 7]. Nerve transfers permit faster reinnervation of muscle than traditional nerve grafting because the nerve repair can be performed much closer to the neuromuscular junction [9]. Application of nerve transfers in the obstetric brachial plexus palsy-affected population is gaining acceptance and is increasingly practiced along with or in lieu of neuroma resection with autologous nerve grafting [2]. While the triceps branch of the radial nerve to the axillary nerve transfer has been described in the adult patient population, there is a paucity of reports of its effectiveness in restoring shoulder abduction in children. In this report, consecutive cases of triceps to axillary nerve transfer in children performed by a single surgeon are reviewed. These nerve transfers were performed for patients with obstetrical brachial plexus palsy and also for traumatic injuries.