Objectives: Shoulder stabilization is of utmost importance in upper extremity reanimation. The purpose of this study is to present our experience of suprascapular nerve reconstruction in 150 cases of obstetrical and adult brachial plexus lesions. Outcomes will be analyzed in relation to various factors including age of the patient, denervation time, donor nerve used, and functional restoration achieved in the supraspinatus versus the infraspinatus muscles.

Methods: The medical records of 165 patients who had suprascapular nerve reconstruction were reviewed. One hundred fifty patients operated by a single surgeon between 1978 and 2000 had adequate follow-up. One hundred two (102) patients were adults, and 48 suffered from obstetrical brachial plexus palsy (OBPP). Direct neurotization of the suprascapular nerve was done in 95 patients while in 55, interposition nerve grafts were used. In 90 patients the distal spinal accessory was used as the motor donor nerve for suprascapular nerve neurotization, while in 60 intraplexus and extraplexus donors were used.

Results: The overall results in adult plexopathies were good or excellent in 75% of the patients for the supraspinatus muscle and in 55% for the infraspinatus muscle. In the OBPP the results were good or excellent in 96% for the supraspinatus muscle and 65% for the infraspinatus muscle. The mean postoperative muscle grading for the distal accessory to suprascapular nerve neurotization was 3.31; for intraplexus to suprascapular neurotization was 3.37; and for cervical plexus to suprascapular neurotization was 3.19. There was a statistically significant difference between direct accessory to suprascapular neurotization versus accessory to suprascapular via a nerve graft ( P < 0.05 )in the posttraumatic group, while in the OBPP patients, although the functional results after direct suprascapular nerve reconstruction were superior to those via graft, there was no statistically significant difference between the two groups ( p=0.027). Early surgery, less than 6 months, yielded significantly better results than late surgery, more than 12 months.

Conclusions: Suprascapular nerve reconstruction is a worthwhile procedure that stabilizes the glenohumeral joint, avoids shoulder arthrodesis, as well as restoring shoulder abduction from 20 to 80 degrees. The best results are seen in the OBPP patients, when direct neurotization of the suprascapular nerve is carried out soon after injury (6 months or less).