Evaluation of single-, double-, and triple-nerve transfers for shoulder abduction in 90 patients with supraclavicular brachial plexus injury

BACKGROUND: Shoulder stability and mobility are critical to upper extremity function. The authors evaluated and compared the results of single-, double-, and triple-nerve transfer techniques in producing shoulder abduction in supraclavicular brachial plexus injuries. METHODS: Between January of 2000 and December of 2004, 90 patients with avulsion type brachial plexus injuries were selected for this study. All patients were operated on by the senior surgeon (D.C.C.C.). The brachial plexus injuries involved avulsion of five or six (including C4) roots in 41 patients (45.6 percent), four-root avulsion in five patients (5.6 percent), three-root avulsion in 25 patients (27.8 percent), two-root avulsion in 15 patients (16.7 percent), and one-root avulsion in four patients (4.4 percent). Ages ranged from 2 to 67 years, with a mean age of 29 years. All patients had nerve transfer for shoulder abduction: 43 (47.8 percent) received a single-nerve transfer, 43 (47.8 percent) received a double-nerve transfer, and four patients (4.4 percent) had a triple-nerve transfer for shoulder function. All patients had a minimum of 3 years' follow-up. Each patient's ability to abduct the shoulder was measured in degrees, and the measurements were compared statistically by nonparametric means. RESULTS: The average degree of shoulder abduction attained was 160 degrees following triple-nerve transfers, 85 degrees following double-nerve transfers, and 65 degrees following single-nerve transfer. The shoulder abduction achieved following either double-nerve transfer or triple-nerve transfer was significantly greater than that achieved by single-nerve transfer. CONCLUSION: Increasing the number of donor nerves used in early-stage nerve transfers to neurotize the avulsed brachial plexus appears to improve subsequent shoulder abduction.