Posterior Approach - Spinal Accessory to Suprascapular Nerve Transfer - Standard
Publicado el 3/7/2014
Posterior Approach - Spinal Accessory to Suprascapular Nerve Transfer
Standard Edition (130422.120309)
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 (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