Nerve Transfer to Serratus Anterior Muscle Using the Thoracodorsal Nerve for Winged Scapula in C5 and C6 Brachial Plexus Root Avulsions

Purpose To report the results of nerve transfer to the serratus anterior muscle using the thoracodorsal nerve for winged scapula in C5 and C6 brachial plexus avulsion. Methods Five patients with a mean age of 27 years with loss of shoulder abduction due to upper brachial plexus injuries and with winged scapula had nerve transfer using 1 branch (1 medial and 4 lateral) of the thoracodorsal nerve to the long thoracic nerve. The spinal accessory nerve and the nerve to the long head of the triceps were used simultaneously for nerve transfer to the suprascapular nerve and the axillary nerve, respectively. The follow-up period ranged from 24 to 33 months (mean, 28 months). Results All patients recovered serratus anterior muscle function. Two patients had no winged scapula, whereas 3 patients had mild winged scapula after the surgery at the last follow-up evaluation. The result was excellent for 2 patients, good for 2 patients, and fair for 1 patient. The mean arcs of motion of shoulder abduction and external rotation were 134 degrees and 124 degrees, respectively. No notable weakness of shoulder adduction was observed. Conclusions Use of the branch of the thoracodorsal nerve ensured adequate return function of the serratus anterior muscle by decreasing or correcting winged scapula in upper brachial plexus injury. We recommend nerve transfer for winged scapula for achieving optimum shoulder function. (J Hand Surg 2009;34A:74-78. Copyright (C) 2009 by the American Society for Surgery of the Hand. All rights reserved.)