{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:22:25Z","timestamp":1784679745133,"version":"3.55.0"},"reference-count":35,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,5,21]],"date-time":"2016-05-21T00:00:00Z","timestamp":1463788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>Our objective was to determine the prevalence and quality of restored external rotation (ER) in adult brachial plexus injury (BPI) patients who underwent spinal accessory nerve (SAN) to suprascapular nerve (SSN) transfer, and to identify patient and injury factors that may influence results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fifty\u2010one adult traumatic BPI patients who underwent SAN to SSN transfer between 2000 and 2013, all treated less than 1 year after injury with &gt;1 year follow\u2010up. The primary outcome measured was shoulder ER. The outcomes we utilized included \u201cclinically useful ER\u201d (motion\u2009\u2265\u2009\u221235\u00b0 with \u2265MRC 2 strength), modified British Medical Research Council (MRC) grading, and electromyographic (EMG) reinnervation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>EMG evidence of re\u2010innervation was found in 85% of patients. Surgery resulted in improved ER in 41% (21\/51) of shoulders at an average of 28 months follow\u2010up. Of these, only 31% (17\/51) had clinically useful ER. The average ER active range of motion was 12\u00b0 from full internal rotation (Range: \u221260\u00b0 to 90\u00b0) and MRC grade 2.2 (2\u20134). The only predictor of ER improvement was an isolated upper trunk (C5\u2010C6) injury. Improved ER was clinically evident in 76%, 37% and 26% of upper trunk (UT), C5\u2010C6\u2010C7 and panplexus injuries, respectively (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although 85% had EMG signs of recovery, the SAN to SSN transfer failed to provide useful recovery of ER through reinnervation of the infraspinatus muscle in injuries involving more levels than a C5\u2010C6 root\/upper trunk pattern. In patients with greater than C5\u20106 level injuries alternatives to SAN to SSN transfer should be considered to restore shoulder ER. \u00a9 2016 Wiley Periodicals, Inc. 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MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle F.","family":"Kircher","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and the Department of Neurosurgery Mayo Clinic 200 First St SW Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Spinner","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and the Department of Neurosurgery Mayo Clinic 200 First St SW Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen T.","family":"Bishop","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and the Department of Neurosurgery Mayo Clinic 200 First St SW Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander Y.","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and the Department of Neurosurgery Mayo Clinic 200 First St SW 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