{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T08:54:23Z","timestamp":1788857663964,"version":"build-2803163510"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2020,2,19]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Shoulder external rotation recovery in brachial plexus birth injury is often limited. Nerve grafting to the suprascapular nerve and transfer of the spinal accessory nerve to the suprascapular nerve are commonly performed to restore shoulder external rotation, but the optimal surgical technique has not been clearly demonstrated. We investigated whether there was a difference between nerve grafting and nerve transfer in terms of shoulder external rotation recovery or secondary shoulder procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This is a multicenter, retrospective cohort study of 145 infants with brachial plexus birth injury who underwent reconstruction with nerve grafting to the suprascapular nerve (n = 59) or spinal accessory nerve to suprascapular nerve transfer (n = 86) with a minimum follow-up of 18 months (median, 25.7 months [interquartile range, 22.0, 31.2 months]). The primary outcome was the Active Movement Scale (AMS) score for shoulder external rotation at 18 to 36 months. The secondary outcome was secondary shoulder surgery. Two-sample Wilcoxon and t tests were used to analyze continuous variables, and the Fisher exact test was used to analyze categorical variables. The Kaplan-Meier method was used to estimate the cumulative risk of subsequent shoulder procedures, and the proportional hazards model was used to estimate hazard ratios (HRs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The grafting and transfer groups were similar in Narakas type, preoperative AMS scores, and shoulder subluxation. The mean postoperative shoulder external rotation AMS scores were 2.70 in the grafting group and 3.21 in the transfer group, with no difference in shoulder external rotation recovery between the groups (difference, 0.51 [95% confidence interval (CI), \u22120.31 to 1.33]). A greater proportion of the transfer group (24%) achieved an AMS score of &gt;5 for shoulder external rotation compared with the grafting group (5%) (odds ratio, 5.9 [95% CI, 1.3 to 27.4]). Forty percent of the transfer group underwent a secondary shoulder surgical procedure compared with 53% of the grafting group; this was a significantly lower subsequent surgery rate (HR, 0.58 [95% CI, 0.35 to 0.95]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Shoulder external rotation recovery in brachial plexus birth injury remains disappointing regardless of surgical technique, with a mean postoperative AMS score of 3, 17% of infants achieving an AMS score of &gt;5, and a high frequency of secondary shoulder procedures in this study. Spinal accessory nerve to suprascapular nerve transfers were associated with a higher proportion of infants achieving functional shoulder external rotation (AMS score of &gt;5) and fewer secondary shoulder procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.19.00627","type":"journal-article","created":{"date-parts":[[2019,11,12]],"date-time":"2019-11-12T05:23:50Z","timestamp":1573536230000},"page":"298-308","source":"Crossref","is-referenced-by-count":32,"title":["Reconstruction of the Suprascapular Nerve in Brachial Plexus Birth Injury"],"prefix":"10.2106","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3992-2806","authenticated-orcid":false,"given":"M. Claire","family":"Manske","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Shriners Hospital for Children\u2014Northern California, Sacramento, California"},{"name":"Department of Orthopedic Surgery, University of California, Davis, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9099-531X","authenticated-orcid":false,"given":"Leslie A.","family":"Kalish","sequence":"additional","affiliation":[{"name":"Boston Children\u2019s Hospital Institutional Centers for Clinical and Translational Research, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2205-2883","authenticated-orcid":false,"given":"Roger","family":"Cornwall","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5822-1039","authenticated-orcid":false,"given":"Allan E.","family":"Peljovich","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Children\u2019s Healthcare of Atlanta, Atlanta, Georgia"},{"name":"The Hand and Upper Extremity Center of Georgia, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7709-3098","authenticated-orcid":false,"given":"Andrea S.","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the TOBI Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,11,12]]},"reference":[{"issue":"6","key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.2106\/JBJS.G.00853","article-title":"The epidemiology of neonatal brachial plexus palsy in the United States","volume":"90","author":"Foad","year":"2008","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"e134","DOI":"10.1097\/BPO.0000000000001089","article-title":"The epidemiology of brachial plexus birth palsy in the United States: declining incidence and evolving risk factors","volume":"39","author":"DeFrancesco","year":"2019","journal-title":"J Pediatr Orthop."},{"issue":"4","key":"bib3-20230810","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1007\/s12178-016-9374-3","article-title":"The natural history and management of brachial plexus birth palsy","volume":"9","author":"Buterbaugh","year":"2016","journal-title":"Curr Rev Musculoskelet Med."},{"issue":"13","key":"bib4-20230810","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.2106\/JBJS.N.00706","article-title":"Surgical anatomy of the supraclavicular brachial plexus","volume":"97","author":"Leung","year":"2015","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib5-20230810","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1111\/j.1469-8749.2004.tb00463.x","article-title":"Natural history of obstetric brachial plexus palsy: a systematic review","volume":"46","author":"Pondaag","year":"2004","journal-title":"Dev Med Child Neurol."},{"issue":"2","key":"bib6-20230810","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1111\/j.1469-8749.2004.tb00455.x","article-title":"Neurological recovery in obstetric brachial plexus injuries: an historical cohort study","volume":"46","author":"Hoeksma","year":"2004","journal-title":"Dev Med Child Neurol."},{"issue":"4","key":"bib7-20230810","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/S0749-0712(21)00264-X","article-title":"An approach to obstetrical brachial plexus injuries","volume":"11","author":"Clarke","year":"1995","journal-title":"Hand Clin."},{"issue":"5","key":"bib8-20230810","doi-asserted-by":"crossref","first-page":"649","DOI":"10.2106\/00004623-199905000-00006","article-title":"Comparison of the natural history, the outcome of microsurgical repair, and the outcome of operative reconstruction in brachial plexus birth palsy","volume":"81","author":"Waters","year":"1999","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib9-20230810","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.ocl.2013.12.004","article-title":"Evaluation and management of brachial plexus birth palsy","volume":"45","author":"Abzug","year":"2014","journal-title":"Orthop Clin North 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palsy","volume":"92","author":"Hogendoorn","year":"2010","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib28-20230810","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1097\/PRS.0b013e3182131c7c","article-title":"Suprascapular nerve reconstruction in obstetrical brachial plexus palsy: spinal accessory nerve transfer versus C5 root grafting","volume":"127","author":"Tse","year":"2011","journal-title":"Plast Reconstr Surg."},{"issue":"5","key":"bib29-20230810","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1097\/PRS.0000000000001096","article-title":"Spinal accessory nerve transfer outperforms cervical root grafting for suprascapular nerve reconstruction in neonatal brachial plexus palsy","volume":"135","author":"Seruya","year":"2015","journal-title":"Plast Reconstr Surg."},{"issue":"4","key":"bib30-20230810","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1097\/PRS.0000000000003668","article-title":"Comparing the efficacy of triple nerve transfers with nerve graft reconstruction in upper trunk obstetric brachial plexus injury","volume":"140","author":"O\u2019Grady","year":"2017","journal-title":"Plast Reconstr Surg."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.19.00627","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:35:59Z","timestamp":1787751359000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.19.00627"}},"subtitle":["A Comparison of Nerve Grafting and Nerve Transfers"],"short-title":[],"issued":{"date-parts":[[2019,11,12]]},"references-count":29,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.19.00627","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,12]]}}}