Medial branch spinal accessory (XI) nerve transfer to Suprascapular nerve through a posterior approach surgical technique
Subscribe to get full access to this operation and the extensive Upper Limb & Hand Surgery Atlas.
Learn the Medial branch spinal accessory (XI) nerve transfer to Suprascapular nerve through a posterior approach surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Medial branch spinal accessory (XI) nerve transfer to Suprascapular nerve through a posterior approach surgical procedure.
The spinal accessory (XIth) nerve transfer to the suprascapular nerve is a reliable technique for restoring function to the supraspinatus and the infraspinatus following a complete injury to the C5 nerve root. The technique was traditionally performed using the lateral branch of the XIth nerve through an anterior approach at the time of neck exploration for a brachial plexus injury and nerve co-aptation was in the anterior wound and proximal to the supra scapular notch. Critical review of the results demonstrates some patients having little functional recovery and generally poor restoration of external rotation. The introduction of a posterior approach allows co-aptation to be performed closer to the paralysed muscles and the SSN can be decompressed at the notch and inspected for damage. Regenerating nerves are generally temporarily more swollen and may auto compress themselves at tight anatomical structures. In the high energy brachial plexus injury the relative tether of the SSN at the supra scapular notch by the supra scapular ligament renders the nerve liable to a traction injury and a rupture or neuroma in continuity may be overlooked when the transfer is performed using the anterior approach. The medial XIth nerve branch is used as the donor nerve in the posterior approach which avoids denervation of the lateral trapezius seen in the anterior approach. The lateral trapezius is important for shoulder elevation and is important for positioning of the arm in cases of complete paralysis of the supraspinatus and deltoid muscles seen after C5 injury. Typically the XI to SSN transfer is combined with transfer of a radial nerve branch from triceps to the axillary nerve in complete C5 lesions. My preferred technique for XI to SSN transfer is using the posterior approach. The procedure is technically more demanding than the anterior approach but with with a co-aptation performed closer to the target and the other advantages already discussed, it is difficult to justify not using this technique.
Author: Dominic Power FRCS Orth, Consultant Hand and Peripheral Nerve Surgeon
Institution: Peripheral Nerve Injury Service, Birmingham Hand Centre, Queen Elizabeth Hospital, UK
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
Our content is designed for both Surgeons in independent practice and Surgeons in training.