Reanimation of Shoulder External Rotation Via Neurotization

Assiut University

Status: Not yet enrolling

Conditions: Nerve Transfer

Treatments: Procedure: Neurotization of Spinal Accessory Nerve To Supra-Scapular in children with OBPP with deficiency of Shoulder External Rotation; Procedure: Neurotization of Spinal Accessory Nerve To Supra-Scapular Nerve

Study type: Interventional

Funder types: Other

Identifiers

NCT06787391

Neurotization in OBPP

Details and patient eligibility

About

Measurement of clinical outcome after nerve transfer in deficiency of shoulder external rotation in children with OBPP.

Full description

Brachial plexus birth injuries (BPBI) occur in 1-2 per 1,000 live births, often resulting from traction on the shoulder during delivery (1). Right-sided injuries are more common due to fetal positioning.(2) BPBI presentations vary, with upper trunk injuries (Erb's palsy) being most frequent, accounting for 45% of cases.(3) These injuries can impair shoulder abduction, external rotation, and arm function ,He can't flex the elbow to partially reache the hand to the mouth (the trumpet sign) .due to suprascapular nerve (SSN) damage, which is prone to stretching due to its fixed attachments.(4)

Erb's palsy affects muscles like the deltoid and biceps, supraspinatus and infraspinatus.(5) . Assessments include testing hand sensation and noting color or trophic changes. Without SSN reconstruction, secondary glenohumeral complications often arise, necessitating surgical interventions like tendon transfers, joint reductions, or osteotomies.(6)

Nerve transfer, such as spinal accessory nerve (SAN) fascicles to the SSN, has shown superior outcomes for restoring shoulder function. The SAN, a pure motor nerve, is well-suited for direct coaptation without interposition grafts.(7).

Surgical approaches include anterior and posterior methods, each with unique benefits. For instance, the anterior approach allows simultaneous brachial plexus exploration and facilitates nerve repair.(8) , while posterior approach prevents double crush phenomenon.(9)

Despite most children recovering spontaneously, 20-30% experience residual deficits (10). Techniques like tension-free SAN-to-SSN repair aim to improve outcomes. This study evaluates the efficacy of SAN transfers in restoring shoulder stability, abduction, and external rotation in BPBI patients.(11)

Enrollment: 25 estimated patients

Sex: All

Ages: 1 to 3 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• children within 1.5 - 3 years .
• No previous surgery
• full passive ROM
• presented with Trumpet sign

Exclusion criteria

• age <1.5 - >3 years
• previous surgery in the shoulder
• Stiff shoulder.
• total OBPP
• traumatic BPI
• follow up <1 year.

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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25 participants in 1 patient group

Just one group of patients children with OBPP presented with deficiency of active shoulder External

Active Comparator group

Treatment:

Procedure: Neurotization of Spinal Accessory Nerve To Supra-Scapular Nerve

Procedure: Neurotization of Spinal Accessory Nerve To Supra-Scapular in children with OBPP with deficiency of Shoulder External Rotation