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Differences in strength fatigue when using different donors in traumatic brachial plexus injuries.

Mariano Socolovsky1, Gonzalo Bonilla2, Ana Carolina Lovaglio2

  • 1Peripheral Nerve & Brachial Plexus Surgery Program, Department of Neurosurgery, Hospital de Clinicas, University of Buenos Aires School of Medicine, 1175 Torre 2 5A, 1428, Buenos Aires, La Pampa, Argentina. marianosocolovsky@gmail.com.

Acta Neurochirurgica
|June 20, 2020
PubMed
Summary

Spinal accessory nerve transfers for elbow flexion show less muscle fatigue than phrenic nerve transfers. Patients receiving spinal accessory nerve (SAN) grafts maintained strength longer than those with phrenic nerve (PN) grafts.

Keywords:
Brachial plexus injuryPhrenic nerve transferSpinal accessory nerve transferStrength endurance

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Area of Science:

  • Neurosurgery
  • Orthopedics
  • Rehabilitation Medicine

Background:

  • Brachial plexus palsy often requires nerve transfers to restore function.
  • Phrenic nerve (PN) and spinal accessory nerve (SAN) are common donor nerves for musculocutaneous nerve (MCN) transfer.
  • Assessing functional outcomes, particularly muscle fatigue, is crucial for selecting optimal donor nerves.

Purpose of the Study:

  • To compare elbow flexion strength fatigue after brachial plexus re-innervation using PN versus SAN.
  • To determine if statistical differences in fatigue exist between PN and SAN donor nerves for MCN transfer.

Main Methods:

  • Retrospective review of patients with severe brachial plexus palsy undergoing PN or SAN to MCN transfer.
  • Maximal contraction strength assessed with a dynamometer.
  • Submaximal and near-maximal contraction duration measured isometrically using 1kg and 2kg weights.
  • Statistical analysis comparing fatigue between PN and SAN groups.

Main Results:

  • Twenty-eight patients included: 21 PN transfers, 7 SAN transfers.
  • SAN transfer group demonstrated significantly less muscle fatigue.
  • SAN group held 1kg and 2kg weights for 91.0s and 61.6s, respectively, versus 41.7s and 19.6s for the PN group (p<0.011).

Conclusions:

  • Phrenic nerve to musculocutaneous nerve transfer results in greater muscular fatigue compared to spinal accessory nerve transfer.
  • Findings suggest SAN may be a superior donor nerve for elbow flexion re-innervation regarding strength endurance.
  • Further research is warranted to fully understand strength endurance and fatigue in nerve re-innervation strategies.