The axillary nerve has several distal branches that provide shoulder function through the innervation of the anterior, middle, and posterior deltoid and teres minor, as well as sensation to the lateral arm. Injury to the axillary nerve has been traditionally viewed as either a complete non-favorable injury where recovery does not occur or a favorable injury where recovery does occur. However, there are situations of mixed injuries where both these scenarios are true, and the axillary nerve has components that will and will not recovery. This mixed nerve injury can be confirmed with the use of electrodiagnostic studies. Management of these cases is to reinnervate the non-recovering components, while protecting the recovering components. The medial triceps branch is an available donor for reconstruction. In this case, the patient suffered an upper brachial plexus injury following a severe fall and lost shoulder function. Electromyography at three months post-injury reported motor unit potentials in the middle and posterior deltoid to recovery, however the anterior deltoid did not have motor unit potentials. Specific reinnervation of the anterior branch of the axillary nerve using the medial triceps branch nerve transfer was elected. This video details the specifics of this nerve transfer.
Standard 150302
Extended 150302
POSITION
Prone.
INCISION
A curved incision along the posterior border of the deltoid with a linear incision between the lateral and long head of the triceps brachii.
REFERENCES
- Khair MM, Schreiber JJ, Rosenblatt L, Byun DJ, Lee SK, Wolfe SW. Axon Counts Yield Multiple Options for Triceps Fascicular Nerve to Axillary Nerve Transfer. J Hand Surg Am. 2016 Nov;41(11):e405-e410. PMID: 27577524.
- Bertelli JA, Ghizoni MF. Nerve transfer from triceps medial head and anconeus to deltoid for axillary nerve palsy. J Hand Surg Am. 2014 May;39(5):940-7. PMID: 24582845.
- Tung TH, Mackinnon SE. Nerve transfers: indications, techniques, and outcomes. J Hand Surg Am. 2010 Feb;35(2):332-41. Review. PMID: 20141906.
- Colbert SH, Mackinnon SE. Nerve transfers for brachial plexus reconstruction. Hand Clin. 2008 Nov;24(4):341-61, v. Review. PMID: 18928885.
- Mackinnon SE, Colbert SH. Nerve transfers in the hand and upper extremity surgery. Tech Hand Up Extrem Surg. 2008 Mar;12(1):20-33. Review. PMID: 18388751.
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.
Great dissection. I had a little chuckle when you were saying how great the length was and then put you finger under to show that it was about 2 finger-breaths.