A Comparison of End-to-End Versus Reverse End-to-Side Nerve Transfer Techniques in Treating Brachial Plexus Birth Injury–Associated Glenohumeral Dysplasia

Background: Glenohumeral dysplasia (GHD) commonly occurs following brachial plexus birth injuries and, if not addressed appropriately, can result in shoulder dysfunction. Despite its severity, there are no clearly defined surgical criteria for correcting GHD. This study compares the outcomes of end-to-end and reverse end-to-side spinal accessory to suprascapular nerve transfers for correction of GHD. Methods: All patients presented with shoulder functional limitations, as indicated by Active Movement Scale (AMS) scores in shoulder abduction, shoulder flexion, and external rotation, and evidence of GHD, confirmed by alpha angle measurements obtained on point-of-care-ultrasounds. Demographics, outcome measures, and differences between cohorts were analyzed and compared. Results: Seven infants underwent treatment with reverse end-to-side at a mean age of 6.0 months and 6 with end-to-end at a mean age of 10.3 months. The mean follow-up time for the reverse end-to-side cohort was 14.1 (SD 6.3) months and 15.1 (SD 5.3) months for the end-to-end cohort. At latest follow-up, both approaches demonstrated significant improvement in all outcome measures with the entirety of the reverse end-to-side cohort achieving full recovery of external rotation postoperatively (AMS 7). When comparing the 2 techniques, both groups exhibited similar functional outcomes with no significant differences noted in GHD correction between the 2 approaches. Conclusion: Depending on the clinical scenario, the reverse end-to-side nerve transfer offers a valuable addition to the therapeutic arsenal for correcting GHD and should be highly considered in treatment options.