Quality of Life in Patients following distal nerve transfers for the Restoration of Shoulder abduction and external rotation - Single centre experience.

Introduction: Restoration of shoulder function is a key objective in brachial plexus surgery, as impaired abduction and external rotation substantially limit upper limb use and quality of life. Distal nerve transfers offer shorter regeneration distances and more predictable outcomes than nerve grafting. Research question: This study evaluated the effectiveness of distal nerve transfers in restoring shoulder function, reducing pain, and improving quality of life in patients with peripheral nerve injuries. Material and methods: A prospective cohort of 36 patients with traumatic brachial plexus or axillary nerve lesions was treated using spinal accessory to suprascapular and/or radial-to-axillary nerve transfers via a posterior approach. Outcomes were assessed two years postoperatively. The primary outcome was the proportion of patients achieving M3-M5 shoulder abduction. Secondary outcomes included external rotation, pain, stability, and the Peripheral Nerve Surgery Quality of Life (PNSQoL) score. Functional recovery was graded using the M0-M5 scale, with M3-M5 considered satisfactory. Results: Satisfactory shoulder abduction was achieved in 91.9% of patients, and satisfactory external rotation in 78.4%. Preoperatively, most patients were classified as having poor or fair PNSQoL, whereas postoperatively the majority shifted to good, very good, or excellent categories. Lesion type significantly influenced external rotation outcomes, with complete brachial plexus palsy showing the poorest results. Younger age and earlier surgery (<6 months) showed trends toward better recovery. Discussion and conclusion: Distal nerve transfers are effective and reproducible procedures for restoring shoulder function, reducing pain, and improving quality of life in patients with brachial plexus injuries.