Nerve transfer from triceps medial head and anconeus to deltoid for axillary nerve palsy.

PURPOSE: To report our results with reconstruction of the axillary nerve by transferring the branch to the triceps lower medial head and anconeus to the anterior division of the axillary nerve.

METHODS: This study included 9 patients with isolated injury of the axillary nerve. Their average age ± SD was 35 ± 9 years, and the mean interval ± SD between injury and surgery was 6.6 ± 2.6 months. Through a posterior arm approach, the radial nerve branch to the lower triceps medial head and anconeus was transferred to the anterior division of the axillary nerve. We observed patients for a mean of 34 ± 7 months. At final evaluation, we measured range of shoulder motion, shoulder abduction and elbow extension strength, and abduction endurance. Patients were assessed via the deltoid extension lag test and abduction-in-internal-rotation test.

RESULTS: All patients recovered deltoid function and maintained full active elbow extension. Seven of 9 patients recovered from lagging abduction in internal rotation. Abduction strength improved from approximately 40% that of the normal side at 90° of abduction preoperatively to 60% of normal strength postoperatively. There was improved endurance in abduction from approximately 25% to 65% that of the normal side, which was sufficient to eliminate all reports of shoulder pain or fatigability.

CONCLUSIONS: Transfer of the radial nerve branch for the lower triceps medial head and anconeus to the anterior division of the axillary nerve proved to be an effective method of deltoid reinnervation.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.