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Subject Area

Peripheral nerves

Article Type

Original Study

Abstract

Background Data: Axillary nerve is one of the branches of the posterior cord of the brachial plexus and carries nerve fibers from C5 and C6 roots, then travels to innervate the deltoid muscle and teres minor muscle, and maintains stability of the shoulder joint plus providing sensation to the overlying skin. Many techniques are present to manage axillary nerve injuries according to the applied anatomy to provide more safety during exploration. It may be isolated or combined injury and each type has its specific protocol.

Study Design: Retrospective clinical case study.

Patients and Methods: Between January 2018 and December 2019, eight male patients with an average age of 32.2 (range, 20 - 45) years presented with complete loss of shoulder abduction. All the patients underwent microsurgical axillary nerve neurotization using transfer of part of the radial nerve of the medial head of the triceps and sutured into the stump of the axillary nerve. The posterior approach in the prone position was used in all patients. The axillary nerve stump was proximal to the origin of the nerve to teres minor muscle. The surgical intervention was done for all eight patients by the same team. Preoperative and follow-up clinical evaluation was done by assessing the motor power of all the patients, which was clinically evaluated using the motor research council (MRC) scale. The mean follow-up period was 12 months.

Results: The eight patients were males and presented after a history of traumatic insults. The average between the traumatic insult and the surgical intervention was 5 (range, 4 - 6) months. Shoulder abduction was grade zero in all patients on the MRC scale. Five patients had complex deficits all over the upper limb among brachial plexus injuries, while three had isolated axillary nerve deficits. In total, 62% of the patients (five patients) showed marked functional motor improvement, while three patients did not show any improvement. Mean time of the surgery was about 80 minutes. Mean amount of blood loss was 160 ml. The average period of recovery was 6 months, while the mean period of follow-up was 32 months.

Conclusion: Harvesting the stump of the axillary nerve proximal to the takeoff of the branch of the teres minor muscle while suturing it with the radial nerve stump through the procedure of nerve transfer is the cardinal step for achieving the functional motor recovery by gaining shoulder abduction. (2021ESJ251)

Keywords

Axillary nerve, nerve transfer, teres minor, posterior approach, shoulder abduction

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