The Middle Trunk Fascicle: A Simple, Effective Nerve Transfer for Suprascapular Nerve in Upper Brachial Plexus Injuries

Abstract

A new nerve transfer option of using viable fascicle of the ipsilateral middle trunk for suprascapular nerve reconstruction is presented. The procedure was used in two patients with upper brachial plexus injury involving loss of shoulder abduction and external rotation. Clinical evaluation and nerve conduction studies in both patients confirmed axonopathy of C5, C6 roots and C5 root, respectively. The proximal root stumps were unavailable for nerve grafting due to a very proximal root level scarring. The middle trunk fascicle was dissected on its superior surface and transferred to the non-functional suprascapular nerve. After 24 months follow up full abduction and external rotation could be achieved in both the patients. It is a simple and easy option for transfer to a suprascapular nerve in upper brachial plexus injuries. It lies next only to the upper trunk and does not require any additional dissection time. Donor deficit was not observed in our two patients.