Medial Triceps to Axillary Nerve Transfer 1 Mackinnon SE1 Yee A1 January 13, 2015Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.Injury to the axillary nerve results in the loss of shoulder function, specifically deltoid and teres minor deficits. This injury can either be isolated or more commonly associated with an upper brachial plexus injury that includes the C5,6 roots. The medial triceps is an available donor for nerve transfer into the axillary nerve and is one part of the double shoulder nerve transfers for shoulder reconstruction following nerve injury. Nerve transfers for the axillary nerve includes reinnervating the deltoid, teres minor, and superior lateral cutaneous nerve territory. In this case, the patient presented six months following a right pan brachial plexus injury with complete C5,6 injury and scapular fracture after a severe ATV accident. While some recovery occurred in the middle/lower plexus, electrodiagnostic studies confirmed no recovery to elbow flexion, deltoid and supra/infraspinatus muscles. The triceps were recovering and thus a medial triceps to axillary nerve transfer was elected with the spinal accessory to suprascapular nerve transfer for shoulder reconstruction. A superior lateral cutaneous end-to-side to radial sensory nerve transfer was also performed for sensation. This video details a reconstruction strategy for the axillary nerve.Keywords: sensory end-to-side nerve transferaxillary nervebrachial plexusnerve transfershoulder functionnerve injurymedial triceps branch of radial nerve Standard Edition Table of Contents- Slow down- Frustration00:00:00 - Introduction00:00:25 - Incision and Superficial Dissection00:02:08 - Dissection along the Posterior Border of the Deltoid00:02:56 - Identifying the Superior Lateral Cutaneous Branch of Axillary Nerve00:03:54 - Identifying the Terminal Branches of the Axillary Nerve00:05:23 - Identification of the Axillary Nerve and Teres Minor Branch00:06:52 - Proximal Division of the Recipient Axillary Nerve00:07:40 - Dissection between the Long and Lateral Head of the Triceps00:09:34 - Identifying the Tendinous Leading-edge of Teres Major00:10:05 - Dissection of the Triangular Space00:11:51 - Identification of the Medial Triceps Branch and Radial Nerve00:13:14 - Neurolysis of the Sensory Component of the Radial Nerve00:13:54 - Distal Dissection and Division of the Medial Triceps Branch00:15:49 - Neurolysis of Superior Lateral Cutaneous Branch from Axillary Nerve00:16:34 - Medial Triceps to Axillary Nerve Transfer00:16:55 - Radial Sensory to Superior Lateral Cutaneous End-to-side Nerve Transfer00:17:12 - Release of the Tendinous Leading-edge of Teres Major Extended Edition Table of Contents- Slow down- Frustration00:00:00 - Introduction00:00:35 - Incision and Superficial Dissection00:04:45 - Dissection along the Posterior Border of the Deltoid00:07:40 - Identifying the Superior Lateral Cutaneous Branch of Axillary Nerve00:09:36 - Identifying the Terminal Branches of the Axillary Nerve00:11:56 - Identification of the Axillary Nerve and Teres Minor Branch00:15:45 - Proximal Division of the Recipient Axillary Nerve00:17:20 - Dissection between the Long and Lateral Head of the Triceps00:20:33 - Identifying the Tendinous Leading-edge of Teres Major00:21:33 - Dissection of the Triangular Space00:25:19 - Identification of the Medial Triceps Branch and Radial Nerve00:27:02 - Neurolysis of the Sensory Component of the Radial Nerve00:28:46 - Distal Dissection and Division of the Medial Triceps Branch00:32:53 - Neurolysis of Superior Lateral Cutaneous Branch from Axillary Nerve00:34:48 - Medial Triceps to Axillary Nerve Transfer00:35:24 - Radial Sensory to Superior Lateral Cutaneous End-to-side Nerve Transfer00:36:41 - Release of the Tendinous Leading-edge of Teres Major POSITION Prone. 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