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Case Reports
. 2020 May 29;15(2):391-393.
doi: 10.4103/ajns.AJNS_160_19. eCollection 2020 Apr-Jun.

Traumatic Partial Posterior Cord Brachial Plexus Injury in a Patient with Aberrant Innervation of the Long Head of the Triceps by the Axillary Nerve: Implications in Nerve Transfer Surgery

Suyash Singh  1 , Kuntal Kanti Das  1 , Harsh Deora  1 , Awadhesh Kumar Jaiswal  1 , Sanjay Behari  1
Affiliations
Case Reports

Traumatic Partial Posterior Cord Brachial Plexus Injury in a Patient with Aberrant Innervation of the Long Head of the Triceps by the Axillary Nerve: Implications in Nerve Transfer Surgery

Suyash Singh et al. Asian J Neurosurg. .

Abstract

Brachial plexus repair forms an unmet need in terms of posttraumatic rehabilitation, especially the young population, wherein the incidence of accidents is high. This leads to decrease in the number of functionally active years after the accident. We encountered an interesting case of posttraumatic posterior cord injury predominantly affecting the shoulder abduction beyond 15°. An electrodiagnostic study showed a complete lack of conduction within the axillary nerve with reduced conduction velocity in the radial nerve. We took the patient up for the long head of the triceps transfer to the anterior division of the axillary nerve transfer. Intraoperatively, we found that the long head branch was originating from the axillary nerve at the point of division. As it could not be used for neurotization, we transferred the medial head branch of the radial nerve to the axillary nerve. The patient started to show electroclinical improvement after 3 months of the surgery. A few similar cases have been published, as a cadaveric finding. We report this case to highlight the possibility and need for a high clinical suspicion and also to provide a possible treatment option, in such aberrant anatomy.

Keywords: Aberrant innervation; Somsak procedure; axillary nerve; brachial plexus injury; long head of triceps.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Intraoperative photos for modified Somsak procedure for shoulder reanimation in brachial plexus injury showing surface marking for surgery, preparation of nerve endings, co-optation with 9-0 suture, and reenforcement with tissue glue
See this image and copyright information in PMC

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