Triceps nerve to deltoid nerve transfer after an unsatisfactory intra-plexus neurotization of the posterior division of the upper trunk

INTRODUCTION: Our literature review did not reveal any study on the results of triceps to deltoid nerve transfer done as a secondary procedure after an unsatisfactory primary intraplexus neurotization of the posterior division of the upper trunk. PRESENTATION OF CASES: We report on three adults with C5-C6 brachial plexus injury who had an unsatisfactory deltoid function following primary intraplexus neurotization. Patients presented to our clinic late (14-16 months after injury). All patients had poor shoulder abduction (<40°) despite the presence of visible and palpable deltoid contractions. A triceps to deltoid nerve transfer resulted in an excellent shoulder abduction (> 150°) in all patients. DISCUSSION: The primary surgery in our patients acted as a "baby-sitter" procedure; explaining the good results of the late secondary distal nerve transfer. CONCLUSION: Good results may be obtained from a late distal nerve transfer for the deltoid muscle as long as there is partial innervation of the muscle.