Posterior Approach – Spinal Accessory to Suprascapular Nerve Transfer
Reconstructing shoulder function following a nerve injury is a challenge due to its dynamic movement originating from several muscles. The supra/infraspinatus muscles are critical for shoulder function in that they initiate abduction of the arm, external rotation, and stabilization of the shoulder joint. In upper brachial plexus injuries, it is common to find a deficit in the suprascapular nerve associated with the axillary and musculocutaneous nerves due to their C5,6 root origins. These patients present with no shoulder function or elbow flexion. Reconstruction includes nerve transfers to innervate the axillary and suprascapular nerves for shoulder function. An available donor nerve for restoring the suprascapular nerve includes the spinal accessory nerve from a posterior or anterior approach. The posterior approach utilizes the distal branches of the accessory nerve that innervates the inferior segments of the trapezius. This video portrays that posterior approach. In this case, a 49-year-old male presented post-Schwannoma resection from the upper brachial plexus with a shoulder and elbow flexion deficit. To reconstruct shoulder function, a spinal accessory to suprascapular nerve transfer was elected with a medial triceps to axillary nerve transfer. To reconstruct elbow flexion, a double fascicular nerve transfer was elected. This video details the posterior approach to reconstructing the suprascapular nerve using the spinal accessory nerve.
Table of Contents (Extended)
Table of Contents (Standard)
00:25 Pre-operative Discussion on Anatomical Landmarks
00:54 Incision / Exposure
01:36 Developing a Superficial Plane to the Trapezius
02:34 Dissection through the Trapezius
03:05 Identifying the Fascial Plane and Fat Deep to the Trapezius
03:50 Identifying and Exposing the Spinal Accessory Nerve
05:04 Dissection through the Trapezius towards the Suprascapular Notch
05:32 Palpating the Suprascapular Notch for Orientation
06:01 Identifying and Exposing the Suprascapular Ligament
06:44 Releasing the Suprascapular Ligament
07:26 Identifying the Suprascapular Nerve
08:17 Proximal Dissection of the Suprascapular Nerve
08:40 Dividing the Suprascapular Nerve Proximally
09:16 Distal Dissection of the Spinal Accessory Nerve
11:37 Dividing the Spinal Accessory Nerve Distally
12:20 Spinal Accessory to Suprascapular Nerve Transfer
Authors: Susan E. Mackinnon, Andrew Yee
Affiliation:
Washington University School of Medicine
Division of Plastic Reconstructive Surgery
Department of Surgery
Saint Louis, MO
Peripheral Nerve Surgery:
http://nervesurgery.wustl.edu
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