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Restoration of shoulder abduction by nerve transfer in avulsed brachial plexus injury: evaluation of 99 patients with various nerve transfers.

During the 5-year period between 1987 and 1991, 99 patients with total root or upper root (C5, C6, or C7) injuries were treated by nerve transfer to obtain shoulder abduction. More than eight different combinations of coaptation between donor nerves (intercostal nerves, phrenic nerve, spinal accessory nerve, ipsilateral C7, or cervical motor nerves) and recipient nerves (suprascapular nerve, axillary nerve, and upper trunk or C5) were applied. All patients had at least 2 years of follow-up. Different results were obtained in each category. Simultaneous neurotization of the suprascapular and axillary nerves with the phrenic and spinal accessory nerves obtained much better and more reliable shoulder abduction. Neurotization of the C5 spinal nerve by multiple nerve transfers was another good option that yielded good shoulder abduction in a single patient. If the phrenic nerve was traumatized, neurotization of the suprascapular nerve solely with the spinal accessory nerve was still capable of achieving an acceptable range of shoulder abduction.