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Structured Motor Rehabilitation After Selective Nerve Transfers
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Modified Partial Radial to Axillary Nerve Transfer.

Ranjan Gupta1, Andrew Li2, Vivian Y Chen1

  • 1Peripheral Nerve Research Lab, Department of Orthopaedic Surgery, University of California Irvine, Irvine, California.

JBJS Essential Surgical Techniques
|June 26, 2025
PubMed
Summary
This summary is machine-generated.

Partial radial to axillary nerve transfer restores shoulder function in patients with brachial plexus injuries. This nerve transfer technique offers a viable solution for improving shoulder abduction and forward flexion.

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Area of Science:

  • Orthopedics
  • Neurosurgery
  • Microsurgery

Background:

  • Brachial plexus injuries often result in severe functional limitations, necessitating alternative treatment options.
  • Nerve transfers bypass injury zones and reduce regeneration time, making them advantageous over other surgical methods.
  • Restoring shoulder function is paramount, making nerve transfer a key consideration for isolated axillary nerve injuries.

Purpose of the Study:

  • To describe the technique of partial radial to axillary nerve transfer for restoring shoulder function.
  • To highlight the rationale and expected outcomes of this specific nerve transfer procedure.

Main Methods:

  • The procedure involves a posterior approach to the proximal humerus with the patient in a lateral decubitus position.
  • An intraoperative nerve stimulator identifies a specific radial nerve branch for transfer to the axillary nerve.
  • Nerve coaptation is performed using microsurgical techniques with interrupted sutures and fibrin glue, ensuring no tension on the repair site.

Main Results:

  • Partial radial to axillary nerve transfer can restore shoulder forward flexion and abduction in cases of persistent axillary nerve paralysis.
  • The radial nerve serves as an ideal donor due to synergistic triceps action and often redundant branches.
  • Patients undergoing this procedure within 6 months of injury show improved Medical Research Council scores and range of motion.

Conclusions:

  • Partial radial to axillary nerve transfer is an effective surgical option for functional recovery of shoulder abduction and flexion.
  • The technique offers a solution for patients with severe brachial plexus injuries and functional limitations.
  • Early surgical intervention (<6 months) is associated with better patient outcomes.