Supercharging of the axillary nerve with a nerve innervating the triceps in a partial traumatic brachial plexus injury of a 5-year-old child in India: a case report.
TL;DR
Nerve transfers offer substantial potential for improved functional recovery and in this case, lateral neurorrhaphy of the nerve to the medial head of the triceps to the axillary nerve provided additional motor input, facilitating earlier deltoid recovery.
Abstract
A 5-year-old girl presented with an inability to abduct her left shoulder and flex her left elbow following a fall 1.5 months earlier. Electrodiagnostic studies were suggestive of a partial upper trunk brachial plexus injury. The child was advised to attend monthly follow-up visits with regular physiotherapy and nerve stimulation. At 3 months after injury, elbow flexion had recovered completely, and shoulder abduction had improved to 30°. After an additional month of observation without further clinical improvement in shoulder abduction, a nerve-to-triceps transfer to the axillary nerve was planned in the fifth month. Intraoperatively, the posterior division of the axillary nerve was found to be excitable. To preserve nerve continuity, an end-to-side supercharging procedure was performed using the nerve to the medial head of the triceps to augment the axillary nerve. The postoperative period was uneventful, and physiotherapy was resumed 3 weeks after surgery. Within 7 months of surgery, the patient demonstrated full shoulder abduction. Restoration of shoulder function is a primary goal in the management of brachial plexus injuries. Nerve transfers offer substantial potential for improved functional recovery. In this case, lateral neurorrhaphy of the nerve to the medial head of the triceps to the axillary nerve provided additional motor input, facilitating earlier deltoid recovery. Early surgical intervention in selected cases may contribute to faster and more effective recovery, particularly in the pediatric population.