Posttraumatic brachial plexopathy in adults is a challenging problem not only due to hand and elbow dysfunction but to loss of shoulder function as well. One hundred seventy-six patients were enrolled in a retrospective review of plexopathy patients undergoing axillary nerve reconstruction from 1978-2006 with greater than 24 month follow-up. One hundered and thirty-five patients had concomittant supraclavicular nerve reconstruction. Most patients had interpositional nerve grafts from intraplexus donors (94 cases) while the rest had extraplexus donors (55 patients), primary repair (13 patients) and microneurolysis (15 patients). Shoulder strength was graded and abduction reported.
Results were good or excellent in 46% of patients (correlating with M3+ or better muscle function). The best outcomes were found in graft lengths of < 6cm, from intrapexus donors, in those who had both axillary and supraclavicular nerve reconstruction, in those with denervation time less than 4 months, those younger than age 20, and those with better preoperative function. Using 3 or more interpositional grafts also improved outcomes.
This paper demonstrates excellent technical correlates for improving success in axillary nerve reconstruction and emphasizes the role of the supraclavicular nerve in shoulder function. This should be reconstructed as well when possible, usually by distal transfer of the spinal accessory nerve leaving the upper nerve branches to the trapezius intact. It also re-emphasizes the point of using standard terminology and grading of outcomes for comparisons across studies. Otherwise, patients in the “fair” category in one study, such as this, may be considered “good” in other studies and make interpretation of the data difficult.