Introduction: Following neuroma resection in obstetric brachial plexus palsy, distal targets are generally reconstructed by interposition nerve grafts from the proximal nerve stumps or by nerve transfer. Transfer of the spinal accessory nerve (CNXI) to the suprascapular nerve (SSN) is one of the most common neurotization procedures, but the comparative efficacy of this technique versus intraplexal grafting has never been objectively established. The null hypothesis of this study was there is no difference in functional outcome - external rotation at the shoulder - following reconstruction of the SSN using either CNXI nerve transfer or grafting from the 5th cervical nerve stump.

Methods: The study is an outcomes analysis of prospectively acquired data from consecutive patients. All patients had the diagnosis of obstetric brachial plexus palsy and underwent exploration of the brachial plexus with neuroma resection. Other than SSN, all distal targets were reconstructed using multi-strand intraplexual grafting. SSN was reconstructed using either CNXI nerve transfer or grafting from the C5 stump. All patients had a minimum of 3 years follow-up with standardized schedule for regular postoperative reexamination. The primary outcome measure was external rotation at the shoulder, as determined during each serial examination by the Active Movement Grading Scale.

Results: 88 patients met inclusion criteria. 33 underwent CNXI transfer. 55 underwent C5 grafting. For either reconstruction technique, there was a statistically significant increase in graded external rotation at 3 years. However, comparing the two techniques, the treatment results were statistically equivalent.

Conclusion: Regardless of the type of reconstruction, all patients experienced significant measurable improvement in external rotation. There was no difference in the magnitude of this improvement for infants undergoing accessory nerve transfer or grafting from the C5 stump. Therefore, the null hypothesis of this study was upheld. The results of the study indicate that both procedures are suitable options for reconstruction of the suprascapular nerve.