[Nerve transfer in isolated deltoid palsy: branch of the long head of the triceps to the axillary nerve]

Abstract

Aim: Nerve transfer of the nerve branch to long head of triceps onto the axillary nerve has joined the therapeutic armamentarium for isolated deltoid paralysis cases. We report our experience in the case of a non-excisable neuroma of the axillary nerve at its origin from the posterior cord.

Methods: Eight patients of average age 28 (15-38) were included in a retrospective study with one operating surgeon. Clinical assessment included analytical testing of the deltoid muscle, pain score (VAS) and a functional assessment. Minimum follow-up was 24 months.

Results: Preoperative delay was 10.8 months. In seven cases, recovery was M4 for the posterior deltoid, M3 for the middle deltoid and M2 for the anterior deltoid. The elbow was stable, strong and painless (VAS=2). Cocontraction was found. No morbidity was found at the donor site. The last case was a failure.

Discussion: In absence of spontaneous recovery, the surgical treatment of deltoid palsy restores a stable strong shoulder and prevents overloading of the rotator cuff. This nerve transfer initially used in brachial plexus surgery gives results comparable to those using grafts, which is the standard treatment of reference avoiding approach of the plexus. The inconvenience is the persistence of cocontractions and a fatigue phenomenon.

Conclusion: The nerve transfer of the nerve to the long head of triceps to the axillary nerve is the technique of choice for re-innervation of the deltoid.