Nerve transfers in the shoulder are devised to restore shoulder function through reinnervation of target muscles. The shoulder is a complex joint that supports movements of the humerus in all degrees of motions and planes. Due to the complexity of the shoulder, the primary muscles that are targeted for reinnervation for the best functional outcome are the deltoid, serratus anterior, and supra/infraspinatus muscles. Several nerve transfers exist to reinnervate these muscles and can be used in combination with each other depending on the case scenario to provide the best functional outcome for shoulder reconstruction.
Nerve transfer combinations include the (1) double shoulder nerve transfer for the suprascapular and axillary nerve and the (2) double level nerve transfer for the long thoracic nerve. The double shoulder nerve transfer includes the combination of spinal accessory to suprascapular nerve and triceps branch to axillary nerve. This nerve transfer combination is commonly utilized together for patients without shoulder function and with available donor nerves. The double level nerve transfer utilizes two donor nerves (pectoral fascicle and thoracodorsal nerve) to reinnervate the long thoracic nerve at the proximal and distal level of the serratus anterior for complete reinnervation of serratus muscle slips.