Spinal Accessory to Suprascapular Nerve Transfer

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   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)
   00:35 Pre-operative Discussion on Anatomical Landmarks
   02:21 Incision / Exposure
   04:28 Developing a Superficial Plane to the Trapezius
   06:42 Dissection through the Trapezius
   08:40 Identifying the Fascial Plane and Fat Deep to the Trapezius
   10:24 Identifying and Exposing the Spinal Accessory Nerve
   12:53 Dissection through the Trapezius towards the Suprascapular Notch
   14:40 Palpating the Suprascapular Notch for Orientation
   15:19 Identifying and Exposing the Suprascapular Ligament
   16:53 Releasing the Suprascapular Ligament
   17:52 Identifying the Suprascapular Nerve
   19:02 Proximal Dissection of the Suprascapular Nerve
   19:35 Dividing the Suprascapular Nerve Proximally
   20:24 Distal Dissection of the Spinal Accessory Nerve
   24:04 Dividing the Spinal Accessory Nerve Distally
   25:15 Spinal Accessory to Suprascapular Nerve Transfer