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 degrees 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. Copyright (C) 2014 by the American Society for Surgery of the Hand. All rights reserved.