Acta Ortopédica Mexicana

Polanco-Armenta AG, Solano-Pérez RJ, Sánchez-Prado MG, Pérez-Atanasio JM, Torres-González R
Efficacy of surgical treatment by radial nerve transfer in patients with traumatic isolated axillary nerve injury
Acta Ortop Mex 2018; 32 (5)

Language: Español
References: 20
Page: 257-262
PDF: 223.52 Kb.

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ABSTRACT

Purpose: To determine the efficacy of surgical treatment by radial nerve transfer in patients with a diagnosis of isolated axillary nerve traumatic injury. Material and methods: We present a series of seven cases, six men and one woman, with a mean age of 51.6 years, with a diagnosis of isolated traumatic axillary nerve injury between January 2013 and December 2016. All patients were treated by radial motor branch nerve transfer of the medial triceps head between the sixth and seventeenth months after trauma, with a minimum follow-up of 12 months. The efficacy of the treatment was evaluated by the Medical Research Council (MRC) and the DASH questionnaire. Results: In the bivariate analysis we found statistically significant differences regarding the degree of external rotation and abduction strength measured by preoperative and postoperative MRC (p ‹ 0.05). The results also demonstrated a statistical significance in the range of postoperative shoulder abduction movement (p = 0.01). The DASH questionnaire showed an average percentage of disability of 20.29% after 12 months of follow-up. Conclusion: Radial nerve transfer in patients diagnosed with axillary nerve traumatic injury provides an excellent degree of improvement in external rotation and abduction strength, in addition to significantly improving the shoulder abduction range, it was also demonstrated by DASH questionnaire that the percentage disability is low.


Key words: Isolated axillary nerve injury, nerve transfer, radial nerve, paralysis, abduction, shoulder.


REFERENCES

  1. Domínguez-Pérez M, Socolovsky M, Di Masi G, Arráez-Sánchez MA. Lesiones traumáticas aisladas del nervio axilar. Experiencia en 4 casos de transferencia nerviosa radial y revisión de la literatura. Neurocirugía [Internet]. 2012; 23(6): 226-33. Disponible en: http://dx.doi.org/10.1016/j.neucir.2012.06.003

  2. Petrucci FS, Morelli A, Raimondi PL. Axillary nerve injuries--21 cases treated by nerve graft and neurolysis. J Hand Surg Am [Internet]. 1982; 7(3): 271-8. Available from: http://dx.doi.org/10.1016/S0363-5023(82)80178-0

  3. Desai MJ, Daly CA, Seiler JG, Wray WH, Ruch DS, Leversedge FJ. Radial to axillary nerve transfers: a combined case series. J Hand Surg Am [Internet]. 2016; 41(12): 1128-34. Available from: http://dx.doi.org/10.1016/j.jhsa.2016.08.022

  4. Addas BM, Midha R. Nerve transfers for severe nerve injury. Neurosurg Clin N Am [Internet]. 2009; 20(1): 27-38. Available from: http://dx.doi.org/10.1016/j.nec.2008.07.018

  5. Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P. Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases. J Hand Surg Am. 2003; 28(4): 633-8.

  6. Alnot JY, Valenti P. Surgical repair of the axillary nerve. Apropos of 37 cases. Int Orthop. 1991; 15(1): 7-11.

  7. Oberlin C, Durand S, Belheyar Z, Shafi M, David E, Asfazadourian H. Nerve transfers in brachial plexus palsies. Chir Main. 2009; 28(1): 1-9.

  8. Tung TH, Mackinnon SE. Nerve transfers: indications, techniques, and outcomes. J Hand Surg Am [Internet]. 2010; 35(2): 332-41. Available from: http://dx.doi.org/10.1016/j.jhsa.2009.12.002

  9. Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P, Malungpaishrope K. Combined nerve transfers for C5 and C6 brachial plexus avulsion injury. J Hand Surg Am. 2006; 31(2): 183-9.

  10. Bertelli JA, Ghizoni MF. Transfer of the accessory nerve to the suprascapular nerve in brachial plexus reconstruction. J Hand Surg Am. 2007; 32(7): 989-98.

  11. Leechavengvongs S, Malungpaishorpe K, Uerpairojkit C, Ng CY, Witoonchart K. Nerve transfers to restore shoulder function. Hand Clin [Internet]. 2016; 32(2): 153-64. Available from: http://dx.doi.org/10.1016/j.hcl.2015.12.004

  12. Miller JH, Garber ST, McCormick DE, Eskandari R, Walker ML, Rizk E, et al. Oberlin transfer and partial radial to axillary nerve neurotization to repair an explosive traumatic injury to the brachial plexus in a child: case report. Childs Nerv Syst. 2013; 29(11): 2105-9.

  13. Bertelli JA, Santos MA, Kechele PR, Ghizoni MF, Duarte H. Triceps motor nerve branches as a donor or receiver in nerve transfers. Neurosurgery. 2007; 61(5 Suppl 2): 333-8; discussion 338-9.

  14. Wood MB, Murray PM. Heterotopic nerve transfers: recent trends with expanding indication. J Hand Surg Am. 2007; 32(3): 397-408.

  15. Uz A, Apaydin N, Bozkurt M, Elhan A. The anatomic branch pattern of the axillary nerve. J Shoulder Elbow Surg. 2007; 16(2): 240-4.

  16. Galvin JW, Eichinger JK. Outcomes following closed axillary nerve injury: a case report and review of the literature. Mil Med [Internet]. 2016; 181(3): e291-7. Available from: http://publications.amsus.org/doi/10.7205/MILMED-D-15-00205

  17. Witoonchart K, Leechavengvongs S, Uerpairojkit C, Thuvasethakul P, Wongnopsuwan V. Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part I: an anatomic feasibility study. J Hand Surg Am. 2003; 28(4): 628-32.

  18. Erhardt AJ, Futterman B. Variations in the innervation of the long head of the triceps brachii: a cadaveric investigation. Clin Orthop Relat Res. 2017; 475(1): 247-50.

  19. Hervás MT, Navarro-Collado MJ, Peiró S, Pérez JLR, López-Matéu P, Martínez-Tello I. Versión española del cuestionario DASH. Adaptación transcultural, fiabilidad, validez y sensibilidad a los cambios. Med Clin (Barc) [Internet]. 2006; 127(12): 441-7. Disponible en: http://linkinghub.elsevier.com/retrieve/pii/S0025775306722898

  20. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ [Internet]. 2008; 337: a1655. Available from: http://www.bmj.com/lookup/doi/10.1136/bmj.a1655