Results of spinal accessory nerve to suprascapular nerve transfers in children with brachial plexus birth injury

Shoulder external rotation after brachial plexus birth injury can be restored by transfer of the spinal accessory nerve to the suprascapular nerve, or more distally to its infraspinatus branch. We studied the outcome of these nerve transfers in 52 patients with a minimum postoperative follow-up of 12 months (mean 7.3 years). The median postoperative improvement in shoulder external rotation was 120° (interquartile range [IQR] 45-135) after anterior and 110° (IQR 83-120) after dorsal spinal accessory nerve transfer to the suprascapular nerve main trunk, and 110° (IQR 80-125) after transfer to the infraspinatus branch. Patients operated after 20 months obtained external rotation ≥90° less frequently. The results of this study suggest that a decision about distal nerve transfer for shoulder external rotation is recommended at 1.5 years of age.<b>Level of evidence:</b> III.