Comparison of spinal accessory nerve transfer to supra-scapular nerve vs. shoulder arthrodesis in adults with brachial plexus injury.
Accessory Nerve
/ surgery
Adolescent
Adult
Arthrodesis
Brachial Plexus
/ injuries
Female
Follow-Up Studies
Humans
Male
Middle Aged
Nerve Transfer
/ methods
Peripheral Nerve Injuries
/ physiopathology
Range of Motion, Articular
Recovery of Function
Reproducibility of Results
Retrospective Studies
Shoulder Joint
/ physiopathology
Treatment Outcome
Young Adult
Brachial plexus
Nerve transfer
Neurotization
Scapulohumeral arthrodesis
Shoulder arthrodesis
Spinal nerve
Journal
Orthopaedics & traumatology, surgery & research : OTSR
ISSN: 1877-0568
Titre abrégé: Orthop Traumatol Surg Res
Pays: France
ID NLM: 101494830
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
02
04
2019
revised:
23
08
2019
accepted:
26
08
2019
pubmed:
5
11
2019
medline:
12
6
2020
entrez:
5
11
2019
Statut:
ppublish
Résumé
Restoring shoulder mobility, stability, and strength is a key goal in patients with brachial plexus injuries. Shoulder arthrodesis is chiefly used as an adjunct to, or after failure of, initial direct nerve surgery. The objective of this study was to compare clinical and functional shoulder outcomes after direct nerve transfer vs. shoulder arthrodesis in adults with supra-clavicular brachial plexus injuries. Shoulder arthrodesis, currently used as a salvage procedure in brachial palsy injuries, deserves to be viewed to a valid alternative to direct nerve transfer. A retrospective study was conducted in 58 patients with a follow-up of at least 2 years. Among them, 20 were managed by transfer of a spinal accessory nerve fascicle to the supra-scapular nerve and 38 by shoulder arthrodesis. Outcome measures were shoulder range-of-motion, isometric shoulder strength, and the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Mean age at surgery was 24 years and mean follow-up was 46 months (range, 24-156 months). Motion ranges of the shoulder were not significantly different between the two treatment groups. Data variance was significantly greater in the nerve transfer group than in the shoulder arthrodesis group for scapular antepulsion (p=0.0011), abduction (p<0.001), and external rotation (p=0.0066). Strength was significantly greater in the arthrodesis group in all directions of motion. The DASH scores showed no significant between-group differences. The results of this study conflict with the widely help opinion that nerve transfer to the supra-scapularis nerve produces better clinical outcomes compared to shoulder arthrodesis. Nerve transfer was not better than shoulder arthrodesis in our patients. The data variance heterogeneity suggests poor predictability and reliability of nerve transfer, in contrast to the modest but predictable and uniform results of shoulder arthrodesis. IV, retrospective observational comparative study.
Sections du résumé
BACKGROUND
Restoring shoulder mobility, stability, and strength is a key goal in patients with brachial plexus injuries. Shoulder arthrodesis is chiefly used as an adjunct to, or after failure of, initial direct nerve surgery. The objective of this study was to compare clinical and functional shoulder outcomes after direct nerve transfer vs. shoulder arthrodesis in adults with supra-clavicular brachial plexus injuries.
HYPOTHESIS
Shoulder arthrodesis, currently used as a salvage procedure in brachial palsy injuries, deserves to be viewed to a valid alternative to direct nerve transfer.
MATERIAL AND METHODS
A retrospective study was conducted in 58 patients with a follow-up of at least 2 years. Among them, 20 were managed by transfer of a spinal accessory nerve fascicle to the supra-scapular nerve and 38 by shoulder arthrodesis. Outcome measures were shoulder range-of-motion, isometric shoulder strength, and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.
RESULTS
Mean age at surgery was 24 years and mean follow-up was 46 months (range, 24-156 months). Motion ranges of the shoulder were not significantly different between the two treatment groups. Data variance was significantly greater in the nerve transfer group than in the shoulder arthrodesis group for scapular antepulsion (p=0.0011), abduction (p<0.001), and external rotation (p=0.0066). Strength was significantly greater in the arthrodesis group in all directions of motion. The DASH scores showed no significant between-group differences.
CONCLUSIONS
The results of this study conflict with the widely help opinion that nerve transfer to the supra-scapularis nerve produces better clinical outcomes compared to shoulder arthrodesis. Nerve transfer was not better than shoulder arthrodesis in our patients. The data variance heterogeneity suggests poor predictability and reliability of nerve transfer, in contrast to the modest but predictable and uniform results of shoulder arthrodesis.
LEVEL OF EVIDENCE
IV, retrospective observational comparative study.
Identifiants
pubmed: 31680015
pii: S1877-0568(19)30306-8
doi: 10.1016/j.otsr.2019.08.018
pii:
doi:
Types de publication
Comparative Study
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1555-1561Informations de copyright
Copyright © 2019 Elsevier Masson SAS. All rights reserved.