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Posterior Deltoid Function After Transfer of Branch to the Long Head Triceps Brachii of the Radial Nerve to the Anterior Branch of the Axillary Nerve

  • Navapong Anantavorasakul
    Correspondence
    Corresponding author: Navapong Anantavorasakul, MD, Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, 190 Silom Road, Bangkok 10500, Thailand.
    Affiliations
    Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand
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  • Pongsiri Piakong
    Affiliations
    Orthopaedic Oncology Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand
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  • Piyabuth Kittithamvongs
    Affiliations
    Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand
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  • Kanchai Malungpaishrope
    Affiliations
    Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand
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  • Chairoj Uerpairojkit
    Affiliations
    Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand
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  • Somsak Leechavengvongs
    Affiliations
    Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand
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      Purpose

      The aim of this study was to evaluate the function of the posterior part of the deltoid after nerve transfer of the long head triceps branch of the radial nerve to the anterior branch of the axillary nerve in patients with an upper brachial plexus injury or isolated axillary nerve injury.

      Methods

      We retrospectively reviewed 26 patients diagnosed with an upper brachial plexus injury or isolated axillary nerve injury who underwent nerve transfer of the long head triceps muscle branch of the radial nerve to the anterior branch of the axillary nerve in our institute between 2012 and 2017. Data on age, sex, the mechanism of injury, the pattern of injury, and operative treatment were collected from medical records. Preoperative and postoperative clinical examinations, including motor powers of shoulder abduction and extension according to Medical Research Council grading, were evaluated. At a minimum of 2 years after the operation, we evaluated the recovery of the posterior deltoid function using the swallow-tail test.

      Results

      Twenty-two patients (84.6%) had recovery of posterior deltoid function confirmed by the swallow-tail test. There were 23 patients (88.5%) who achieved at least Medical Research Council grade 4 of shoulder abduction.

      Conclusions

      Nerve transfer from the branch to the long head triceps to the anterior branch of the axillary nerve is an effective technique for restoring deltoid function in an upper brachial plexus injury or isolated axillary nerve injury. This technique can provide shoulder abduction and shoulder extension, which are the functions of the posterior deltoid muscle.

      Type of study/level of evidence

      Therapeutic IV.

      Key words

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      References

        • Leechavengvongs S.
        • Malungpaishorpe K.
        • Uerpairojkit C.
        • Ng C.Y.
        • Witoonchart K.
        Nerve transfers to restore shoulder function.
        Hand Clin. 2016; 32: 153-164
        • Maldonado A.A.
        • Bishop A.T.
        • Spinner R.J.
        • Shin A.Y.
        Five operations that give the best results after brachial plexus injury.
        Plast Reconstr Surg. 2017; 140: 545-556
        • 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: 628-632
        • 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: 633-638
        • Loukas M.
        • Grabska J.
        • Tubbs R.S.
        • Apaydin N.
        • Jordan R.
        Mapping the axillary nerve within the deltoid muscle.
        Surg Radiol Anat. 2009; 31: 43-47
        • Hong T.C.
        • Kumar V.P.
        • Nather A.
        The posterior neuromuscular compartment of the deltoid.
        Plast Reconstr Surg. 2005; 115: 1660-1664
        • Zhao X.
        • Hung L.K.
        • Zhang G.M.
        • Lao J.
        Applied anatomy of the axillary nerve for selective neurotization of the deltoid muscle.
        Clin Orthop Relat Res. 2001; 390: 244-251
        • Ball C.M.
        • Steger T.
        • Galatz L.M.
        • Yamaguchi K.
        The posterior branch of the axillary nerve: an anatomic study.
        J Bone Joint Surg Am. 2003; 85: 1497-1501
        • Uz A.
        • Apaydin N.
        • Bozkurt M.
        • Elhan A.
        The anatomic branch pattern of the axillary nerve.
        J Shoulder Elbow Surg. 2007; 16: 240-244
      1. Bertelli JA, Goklani MS, Gasparelo KR, Seltser A. Transdeltoid approach to axillary nerve repair: anatomical study and case series. J Hand Surg Am. Published online November 8, 2021. https://doi.org/10.1016/j.jhsa.2021.09.017.

        • Leechavengvongs S.
        • Teerawutthichaikit T.
        • Witoonchart K.
        • et al.
        Surgical anatomy of the axillary nerve branches to the deltoid muscle.
        Clin Anat. 2015; 28: 118-122
        • Nishijma N.
        • Yamamuro T.
        • Fujio K.
        • Ohba M.
        The swallow-tail sign: a test of deltoid function.
        J Bone Joint Surg Br. 1995; 77: 152-153
        • Bertelli J.A.
        • Ghizoni M.F.
        Abduction in internal rotation: a test for the diagnosis of axillary nerve palsy.
        J Hand Surg Am. 2011; 36: 2017-2023
        • Wells M.E.
        • Gonzalez G.A.
        • Childs B.R.
        • Williams M.R.
        • Nesti L.J.
        • Dunn J.C.
        Radial to axillary nerve transfer outcomes in shoulder abduction: a systematic review.
        Plast Reconstr Surg Glob Open. 2020; 8e3096
        • Terzis J.K.
        • Kostas I.
        • Soucacos P.N.
        Restoration of shoulder function with nerve transfers in traumatic brachial plexus palsy patients.
        Microsurgery. 2006; 26: 316-324
        • Samardzic M.
        • Grujicic D.
        • Antunovic V.
        Nerve transfer in brachial plexus traction injuries.
        J Neurosurg. 1992; 76: 191-197
        • Merrell G.A.
        • Barrie K.A.
        • Katz D.L.
        • Wolfe S.W.
        Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature.
        J Hand Surg Am. 2001; 26: 303-314
        • Chuang D.C.
        • Lee G.W.
        • Hashem F.
        • Wei F.C.
        Restoration of shoulder abduction by nerve transfer in avulsed brachial plexus injury: evaluation of 99 patients with various nerve transfers.
        Plast Reconstr Surg. 1995; 96: 122-128
        • Travill A.A.
        Electromyographic study of the extensor apparatus of the forearm.
        Anat Rec. 1962; 144: 373-376
        • Magermans D.J.
        • Chadwick E.K.
        • Veeger H.E.
        • van der Helm F.C.
        Requirements for upper extremity motions during activities of daily living.
        Clin Biomech (Bristol, Avon). 2005; 20: 591-599
        • van Andel C.J.
        • Wolterbeek N.
        • Doorenbosch C.A.
        • Veeger D.H.
        • Harlaar J.
        Complete 3D kinematics of upper extremity functional tasks.
        Gait Posture. 2008; 27: 120-127
        • Hertel R.
        • Lambert S.M.
        • Ballmer F.T.
        The deltoid extension lag sign for diagnosis and grading of axillary nerve palsy.
        J Shoulder Elbow Surg. 1998; 7: 97-99