The Utilization of Nerve Transfer for Reestablishing Shoulder Function in the Setting of Acute Flaccid Myelitis: A Single-Institution Review.
BACKGROUND
Acute flaccid myelitis (AFM) is a rare disease of young children. The typical presentation involves acute-onset flaccid paralysis in one or more extremities with a nonspecific viral prodrome. Long-term outcomes demonstrate that functional recovery plateaus around six to nine months. The purpose of this study was to evaluate the efficacy of nerve transfers for restoring shoulder function in these patients.


METHODS
A retrospective review of all patients diagnosed with AFM at a single institution. Shoulder function was evaluated using the active movement scale (AMS). Children at a minimum of six months after diagnosis with plateaued shoulder AMS scores of 4 or less were indicated for surgery.


RESULTS
Eleven patients were identified with a mean time from symptom onset to surgery of 12 months. Average follow-up was 19 months. The mean AMS score at follow-up for shoulder external rotation and abduction was 4.6 and 2.8, respectively. A total of six different nerve transfers with five different donor nerves were used individually or in conjunction with each other. The most common transfers were from the spinal accessory nerve to the suprascapular nerve (n = 8) and from the intercostal nerves ×3 to the axillary nerve (n = 5). Patients who received a transfer from the radial nerve to the axillary nerve (n = 2) had the best functional returns, with the mean AMS score of 6.5 in both external rotation and abduction at follow-up.


CONCLUSION
Nerve transfer procedures may help restore shoulder function in the setting of AFM. Combination procedures that involve a transfer from the radial nerve to the axillary nerve may provide the best functional results.
['Paziuk|Taylor M|TM|', 'Tadley|Madeline|M|', 'Aversano|Michael|M|', 'Kozin|Scott H|SH|', 'Zlotolow|Dan A|DA|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D020805:Central Nervous System Viral Diseases D002648:Child D002675:Child, Preschool D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D009187:Myelitis D016067:Nerve Transfer D009468:Neuromuscular Diseases D017063:Outcome Assessment, Health Care D010525:Peripheral Nerves D012189:Retrospective Studies D012782:Shoulder
Nerve transfer Shoulder AFM Peripheral nerve Rehabilitation