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Published on: April 18, 2020
Modified partial radial to axillary nerve transfer as the index procedure for isolated axillary nerve injury
Ranjan Gupta1, Tyler R Johnston2, Chris Lee2
1Department of Orthopaedic Surgery, University of California, Orange, CA, USA; Reeve-Irvine Research Center, University of California, Irvine, CA, USA; Department of Orthopaedic Surgery, Creighton University, Omaha, NE, USA.
Background:
Axillary nerve injuries often produce profound functional deficits. Beyond expectant management or microsurgical repair, treatment is generally limited to salvage procedures. We present the results of partial radial-to-axillary nerve transfer as the index procedure for treatment of axillary nerve injury after failure of initial conservative management.
Methods:
Minimum 2-year follow-up data were collected and retrospectively analyzed for this single-surgeon cohort of patients with isolated axillary nerve injury. The injury was confirmed with electromyography, and all patients underwent a nerve transfer as the index intervention. All patients were evaluated for donor-site neuromuscular morbidity, and deltoid muscle biopsies were obtained intraoperatively from 8 patients for motor endplate (MEP) morphometric analysis. Age at time of surgery ranged from 22-68 years, and time from injury to surgery ranged from 2-120 months. Shoulder range of motion and Medical Research Council muscle strength scores were recorded preop and postop.
Results:
There were 16 patients in the final sample (median age 56, 15 males, 1 female, 93.75% White, 6.25% Black). Significant improvements in pre-op versus final post-op function were observed: average Medical Research Council score improved by 2.82 ± 1.33 (P < .01), while average active forward-flexion improved by 108° ± 44° (P < .01), abduction by 95° ± 42° (P < .01), and external rotation by 37° ± 27° (P < .01). Surviving MEPs were observed in biopsies of denervated muscles from all patients, even those greater than 6 months from injury.
Conclusion:
In patients with an isolated axillary nerve injury, when an appropriate donor radial nerve branch can be identified, partial radial-to-axillary nerve transfer as the index treatment procedure offers the possibility of significantly improving shoulder motion and functional strength, without detectable donor-site morbidity. Furthermore, the opportunity for meaningful functional improvement was observed even in patients treated with surgery beyond 6 months from the time of nerve injury and correlated with the observed persistence of deltoid MEPs at later time points.
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