Posterior Approach – Spinal Accessory to Suprascapular Nerve Transfer 2 Mackinnon SE1 Yee A1 July 3, 2014Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.Reconstructing shoulder function following a nerve injury is a challenge due to its dynamic movement originating from several muscles. The supra/infraspinatus muscles are critical for shoulder function in that they initiate abduction of the arm, external rotation, and stabilization of the shoulder joint. In upper brachial plexus injuries, it is common to find a deficit in the suprascapular nerve associated with the axillary and musculocutaneous nerves due to their C5,6 root origins. These patients present with no shoulder function or elbow flexion. Reconstruction includes nerve transfers to innervate the axillary and suprascapular nerves for shoulder function. An available donor nerve for restoring the suprascapular nerve includes the spinal accessory nerve from a posterior or anterior approach. The posterior approach utilizes the distal branches of the accessory nerve that innervates the inferior segments of the trapezius. This video portrays that posterior approach. In this case, a 49-year-old male presented post-Schwannoma resection from the upper brachial plexus with a shoulder and elbow flexion deficit. To reconstruct shoulder function, a spinal accessory to suprascapular nerve transfer was elected with a medial triceps to axillary nerve transfer. To reconstruct elbow flexion, a double fascicular nerve transfer was elected. This video details the posterior approach to reconstructing the suprascapular nerve using the spinal accessory nerve.Keywords: suprascapular nervebrachial plexusnerve transfershoulder functionsuprascapular notchnerve injuryspinal accessory nerve You must login to view the full article and extended video on this page. Standard Edition Table of Contents- Slow down- Frustration00:00:00 - Introduction00:00:25 - Pre-operative Discussion on Anatomical Landmarks00:00:54 - Incision / Exposure00:01:36 - Developing a Superficial Plane to the Trapezius00:02:34 - Dissection through the Trapezius00:03:05 - Identifying the Fascial Plane and Fat Deep to the Trapezius00:03:50 - Identifying and Exposing the Spinal Accessory Nerve00:05:04 - Dissection through the Trapezius towards the Suprascapular Notch00:05:32 - Palpating the Suprascapular Notch for Orientation00:06:01 - Identifying and Exposing the Suprascapular Ligament00:06:44 - Releasing the Suprascapular Ligament00:07:26 - Identifying the Suprascapular Nerve00:08:17 - Proximal Dissection of the Suprascapular Nerve00:08:40 - Dividing the Suprascapular Nerve Proximally00:09:16 - Distal Dissection of the Spinal Accessory Nerve00:11:37 - Dividing the Spinal Accessory Nerve Distally00:12:20 - Spinal Accessory to Suprascapular Nerve Transfer You must login to view the full article and extended video on this page. Leave a Comment Cancel replyYou must be logged in to post a comment.