Posterior Approach - Spinal Accessory to Suprascapular Nerve Transfer
Extended 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 (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
Authors: Susan E. Mackinnon, Andrew Yee