Clinical neurology and neurosurgery · 2026
Is there still a role for the medial pectoral nerve as a donor for axillary reinnervation in partial brachial plexus injury?
СтатьяНазвание и аннотация: Перевод в очереди
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Martins Roberto S, Burgos-Morales Natalia, Siqueira Mario G, De Freitas Bruno S A G, Heise Carlos O
Аннотация
OBJECTIVE: to assess axillary nerve reinnervation when utilizing either a radial nerve branch to triceps muscle (RB) or through using the medial pectoral nerve (MP) as donors for patients with partial brachial plexus injuries.
METHODS: We performed a retrospective study with 55 patients who received treatment for partial brachial plexus injuries. The patients were divided into RB (n = 29) or MP (n = 26) groups based on donor nerve used to reinnervate the axillary nerve. The shoulder abduction and its external rotation were assessed after a minimum of 18 months after surgery by using the Medical Research Council (MRC) scale for muscle strength and goniometer to measure range of motion. Outcomes were categorized into specific criteria (abduction ≥ 45°, external rotation ≥ 90°, and strength ≥ MRC grade 3). Statistical analysis included comparing variables using Student's t test or the Wilcoxon test and categorical variables using chi square test while logistic regression was used to study the impact of donor nerve on dichotomized outcomes.
RESULTS: The findings showed that both groups were demographically comparable. Shoulder abduction strength ≥ 3 on the MRC scale was achieved in 75.9% of the RB group and 76.9% of the MP group, with median abduction angles of 55° and 45°, respectively (p > 0.4). The RB group exhibited higher external rotation strength and range (with median strength of 3 and median angle of 90°) compared to MP group (median strength of 1, and median angle of 10°; with p = 0.03 for both comparisons).The analysis with logistic regression showed that utilizing a radial nerve branch raised the chances of attaining a strength level ≥ 3 by 3 times (odds ratio 3.58) with a confidence interval ranging from 1;19-11;50; however it did not impact achieving external rotation ≥ 90°.
CONCLUSIONS: axillary nerve reinnervation with the radial nerve branch provides better external rotation strength and range of motion when compared with medial pectoral nerve transfer, while both approaches provide similar shoulder abduction results. The medial pectoral nerve should only be used when the radial nerve branch is unavailable as a donor.
METHODS: We performed a retrospective study with 55 patients who received treatment for partial brachial plexus injuries. The patients were divided into RB (n = 29) or MP (n = 26) groups based on donor nerve used to reinnervate the axillary nerve. The shoulder abduction and its external rotation were assessed after a minimum of 18 months after surgery by using the Medical Research Council (MRC) scale for muscle strength and goniometer to measure range of motion. Outcomes were categorized into specific criteria (abduction ≥ 45°, external rotation ≥ 90°, and strength ≥ MRC grade 3). Statistical analysis included comparing variables using Student's t test or the Wilcoxon test and categorical variables using chi square test while logistic regression was used to study the impact of donor nerve on dichotomized outcomes.
RESULTS: The findings showed that both groups were demographically comparable. Shoulder abduction strength ≥ 3 on the MRC scale was achieved in 75.9% of the RB group and 76.9% of the MP group, with median abduction angles of 55° and 45°, respectively (p > 0.4). The RB group exhibited higher external rotation strength and range (with median strength of 3 and median angle of 90°) compared to MP group (median strength of 1, and median angle of 10°; with p = 0.03 for both comparisons).The analysis with logistic regression showed that utilizing a radial nerve branch raised the chances of attaining a strength level ≥ 3 by 3 times (odds ratio 3.58) with a confidence interval ranging from 1;19-11;50; however it did not impact achieving external rotation ≥ 90°.
CONCLUSIONS: axillary nerve reinnervation with the radial nerve branch provides better external rotation strength and range of motion when compared with medial pectoral nerve transfer, while both approaches provide similar shoulder abduction results. The medial pectoral nerve should only be used when the radial nerve branch is unavailable as a donor.