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A surgical approach to incomplete axillary nerve injuries: supercharge reverse end-to-side
Shayoni Nag, Patrick Kennedy, Julie West, Amy M. Moore
The Ohio State Wexner Medical Center Department of Plastic and Reconstructive Surgery
2024-12-10
Presenter: Shayoni Nag
Affidavit:
Amy M. Moore
Director Name: Amy M. Moore
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Hand
Background:
Axillary nerve injury is a common cause of impaired shoulder abduction and forward flexion, often accompanied by neuropathic pain and numbness. Beyond trauma and iatrogenic causes, compression of the axillary nerve in the quadrangular space (QS) can lead to persistent injury and pain. While complete axillary nerve injuries are treated with nerve repair, grafting, or end-to-end transfers, incomplete injuries that fail to resolve may benefit from QS decompression with or without supercharged end-to-side (SETS) nerve transfers. SETS transfers bring additional axons closer to motor end plates, offering a potential solution for severe incomplete axillary nerve injuries. This study explores the role of nerve surgery in managing incomplete axillary nerve injuries, focusing on QS decompression with or without SETS transfers. We hypothesize that this approach improves outcomes in patients with incomplete injuries unresponsive to non-operative management.
Methods:
A retrospective review of patients who underwent QS decompression with or without selective medial triceps-to-axillary nerve transfer at Ohio State University Wexner Medical Center (January 2020–July 2024) was conducted. Primary outcomes included shoulder abduction strength (MRC scale) and pain (VAS). Demographic, injury, and surgical variables were also analyzed.
Results:
Eighteen patients underwent surgery at an average of 12.7 months post-injury. Post-operatively, 83.3% achieved an MRC grade ≥3, compared to 44.4% pre-operatively. Mean MRC scores improved from 2.77±1.42 to 4.08±0.86 (p<0.001), and VAS pain scores decreased from 6.06±2.77 to 2.47±1.94 (p<0.001).
Conclusions:
QS decompression with or without SETS transfer significantly improves shoulder abduction and reduces pain, supporting its role in managing incomplete axillary nerve injuries.
