A 32-year-old man with global brachial plexus palsy (C5–T1 avulsion) undergoes nerve transfer surgery. The intercostal nerves (T3–T5) are used as donors for reinnervating biceps via musculocutaneous nerve to restore elbow flexion. Which additional nerve transfer is classically described to restore shoulder abduction in this scenario?

• A Phrenic nerve to axillary nerve
• B Hypoglossal nerve to long thoracic nerve
• C Spinal accessory nerve (CN XI) to suprascapular nerve ✓
• D Contralateral C7 to suprascapular nerve

Explanation

Spinal accessory nerve (CN XI) to suprascapular nerve transfer is the classic and most reliable nerve transfer for restoring shoulder abduction (supraspinatus, infraspinatus function) in brachial plexus avulsion injuries. CN XI is preferred because it is expendable (trapezius partially compensates), has a large axon count, and is close to the suprascapular nerve, minimizing regeneration distance. Phrenic nerve transfer carries the risk of respiratory compromise. Contralateral C7 is used for hand/wrist reconstruction. Hypoglossal nerve to long thoracic nerve is not a standard procedure. Intercostal nerves are specifically targeted to musculocutaneous for elbow flexion.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.