Pathological findings identified during the posterior approach to the spinal accessory nerve after high-energy trauma
Abstract
The spinal accessory to suprascapular nerve transfer is a key procedure for restoring shoulder function in upper brachial plexus injuries and is typically undertaken via an anterior approach. The anterior approach may miss injury to the suprascapular nerve about the suprascapular notch, which may explain why functional outcomes are often limited. In 2014 we adopted a posterior approach to enable better visualization of the suprascapular nerve at the notch. Over the next 6 years we have used this approach for 20 explorations after high-energy trauma. In 7/20 we identified abnormalities at the level of the suprascapular ligament, which we would not have identified with an anterior approach: there were two ruptures, two neuromas-in-continuity and three cases of scar encasement, necessitating neurolysis. Nerve transfer could be undertaken distal to the suprascapular notch, bypassing the site of injury. These pathological findings support the wider adoption of the posterior approach in cases of high-energy trauma.Level of evidence: IV.
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Date
2021-09-02
Type
Article
Subject
Neurology, Surgery
Collections
Citation
Power DM, Jimulia D, Malone P, Shirley C, Chaudhry T. Pathological findings identified during the posterior approach to the spinal accessory nerve after high-energy trauma. J Hand Surg Eur Vol. 2022 Apr;47(4):393-398. doi: 10.1177/17531934211039698. Epub 2021 Sep 2
Journal / Source Title
The Journal of Hand Surgery
DOI
10.1177/17531934211039698
PMID
34472393
Publisher
SAGE Publications
Publisher’s URL
https://journals.sagepub.com/home/JHS