Nerve Transfers for Elbow Flexion in Traumatic Brachial Plexus Injuries
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Published:
Aug 31, 2022
Keywords:
Nerve transfers, elbow flexion, brachial plexus injury
Main Article Content
Abstract
Objective: To evaluate the results of different nerve transfers used for elbow flexion in patients with traumatic brachial plexus injury.
Materials and Methods: Between April 2012 and January 2019, 13 patients (12 men) with traumatic brachial plexus injury underwent surgery. 5 patients had total paralysis and did not recover, 4 had total paralysis and partially recovered the lower trunk, and 4 had high paralysis. The nerve transfers performed for elbow flexion were: 3 intercostal nerves with a sural graft to the musculocutaneous nerve or its motor branch(es) (4 patients), 3 intercostal nerves to the musculocutaneous nerve without graft (3 patients), the accessory spinal nerve to motor branches of the musculocutaneous nerve with sural graft (2 patients), fascicles of the ulnarnerve to the motor branch of the biceps (3 patients) and fascicles of the ulnar nerve and fascicles of the median nerve to the motor branches of the biceps and anterior brachialis (3 patients). We assessed elbow flexion strength (M0-M5), pain on the visual analog scale, and DASH score. The average follow-up was 50 months.
Results: Elbow flexion strength was M5 (1 patient), M4 (7 patients), M3 (1 patient), M2 (1 patient), and M1 (2 patients). The mean DASH score was 54.1 before surgery and 29.5 postoperatively. The preoperative pain score was 7 and 0.9 postoperatively. There were no complications.
Conclusions: Nerve transfers achieved satisfactory outcomes for active elbow flexion reconstruction in patients with brachial plexus injury.
Materials and Methods: Between April 2012 and January 2019, 13 patients (12 men) with traumatic brachial plexus injury underwent surgery. 5 patients had total paralysis and did not recover, 4 had total paralysis and partially recovered the lower trunk, and 4 had high paralysis. The nerve transfers performed for elbow flexion were: 3 intercostal nerves with a sural graft to the musculocutaneous nerve or its motor branch(es) (4 patients), 3 intercostal nerves to the musculocutaneous nerve without graft (3 patients), the accessory spinal nerve to motor branches of the musculocutaneous nerve with sural graft (2 patients), fascicles of the ulnarnerve to the motor branch of the biceps (3 patients) and fascicles of the ulnar nerve and fascicles of the median nerve to the motor branches of the biceps and anterior brachialis (3 patients). We assessed elbow flexion strength (M0-M5), pain on the visual analog scale, and DASH score. The average follow-up was 50 months.
Results: Elbow flexion strength was M5 (1 patient), M4 (7 patients), M3 (1 patient), M2 (1 patient), and M1 (2 patients). The mean DASH score was 54.1 before surgery and 29.5 postoperatively. The preoperative pain score was 7 and 0.9 postoperatively. There were no complications.
Conclusions: Nerve transfers achieved satisfactory outcomes for active elbow flexion reconstruction in patients with brachial plexus injury.
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How to Cite
Gardenal, R. M., Vélez, M., Glasberg, E., Seri, M., Faccendini, S., Slullitel, M., Bichara, J., & Capomassi, M. (2022). Nerve Transfers for Elbow Flexion in Traumatic Brachial Plexus Injuries. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(4), 507-516. https://doi.org/10.15417/issn.1852-7434.2022.87.4.1503
Section
Clinical Research
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References
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2. Wood MB, Murray PM. Heterotopic nerve transfers: Recent trends with expanding indication. J Hand Surg Am
2007;32(3):397-408. https://doi.org/10.1016/j.jhsa.2006.12.012
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Argent Ortop Traumatol 2010;75(2):192-9. Available at: https://www.aaot.org.ar/revista/2010/n2/Rev_
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5. Chwei-Chin Chuang D. Nerve transfers in adult brachial plexus injuries: My methods. Hand Clin 2005;21(1):71-
82. https://doi.org/10.1016/j.hcl.2004.10.004
6. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH
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Ind Med1996;29(6):602-8. https://doi.org/10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L
7. Medical Research Council. Aids to the investigation of peripheral nerve injuries. 2nd ed. London: Her Majesty’s
Stationery Office, 1942.
8. Merrell GA, Barrie KA, Katz DL, Wolfe SW. Results of nerve transfer techniques for restoration of shoulder and
elbow function in the context of a meta-analysis of the English literature. J Hand Surg Am 2001;26(2):303-14.
https://doi.org/10.1053/jhsu.2001.21518
9. Mackinnon SE, Colbert SH. Nerve transfers for brachial plexus reconstruction. Hand Clin 2008;24(4):341-61.
https://doi.org/10.1016/j.hcl.2008.07.001
10. Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P, Ketmalasiri W. Nerve transfer to biceps
muscle using a part of the ulnar nerve in brachial plexus injury (upper arm type): a report of 32 cases. J Hand Surg 1998;23(4):711-6. https://doi.org/10.1016/S0363-5023(98)80059-2
11. Oberlin C. Nerve transfer to biceps muscle using a part of ulnar nerve for C5-6 avulsion of the brachial plexus—anatomical studies and report of four cases. J Hand Surg Am 1994;19(2):232-7. https://doi.org/10.1016/0363-5023(94)90011-6
12. Humphreys DB, Mackinnon SE. Nerve transfers. Oper Tech Plastic Reconstruct Surg 2002;9(3):89-99.
https://doi.org/10.1053/otpr.2003.S1071-0949(03)00057-X
13. Goubier J-N, Teboul F. Technique of the double nerve transfer to recover elbow flexion in C5, C6, or C5 to C7
brachial plexus palsy. Tech Hand Up Extrem Surg 2007;11(1):15-7. https://doi.org/10.1097/01.bth.0000248360.14448.6b
14. Ray WZ, Pet MA, Yee A, Mackinnon SE. Double fascicular nerve transfer to the biceps and brachialis muscles after brachial plexus injury: clinical outcomes in a series of 29 cases. J Neurosurg 2011;114(6):1520-8.
https://doi.org/10.3171/2011.1.JNS10810
15. Liverneaux PA, Diaz LC, Beaulieu JY, Durand S, Oberlin C. Preliminary results of double nerve transfer to restore elbow flexion in upper type brachial plexus palsies. Plast Reconstr Surg 2006;117(3):915-9.
https://doi.org/10.1097/01.prs.0000200628.15546.06
16. Carlsen BT, Kircher MF, Spinner RJ, Bishop AT, Shin AY. Comparison of single versus double nerve transfers for
elbow flexion after brachial plexus injury. Plast Reconstr Surg 2011;127(1):269-76. https://doi.org/10.1097/PRS.0b013e3181f95be7
17. Martins RS, Siqueira MG, Heise CO, Foroni L, Teixeira MJ. A prospective study comparing single and double
fascicular transfer to restore elbow flexion after brachial plexus injury. Neurosurgery 2013;72(5):709-14; discussion 714-5; quiz 715. https://doi.org/10.1227/NEU.0b013e318285c3f6
2005;21(1):47-54. https://doi.org/10.1016/j.hcl.2004.09.007
2. Wood MB, Murray PM. Heterotopic nerve transfers: Recent trends with expanding indication. J Hand Surg Am
2007;32(3):397-408. https://doi.org/10.1016/j.jhsa.2006.12.012
3. Palazzi Coll S, Cáceres Lucero J. Lesiones del plexo braquial en el adulto: parte 2. Rev Asoc Argent Ortop
Traumatol 2000;65(2):148-55. Available at: https://www.aaot.org.ar/revista/1993_2002/2000/2000_2/650209.pdf
4. Boretto J, Alfie V, Thomas MG, Galucci G, De Carli P. Neurotizaciones extraplexuales e intraplexuales en
el tratamiento de las avulsiones radiculares (C5-C6) traumáticas del plexo braquial del adulto. Rev Asoc
Argent Ortop Traumatol 2010;75(2):192-9. Available at: https://www.aaot.org.ar/revista/2010/n2/Rev_
AsocArgentOrtopTraumatol_2010_75_192-199_Boretto.pdf
5. Chwei-Chin Chuang D. Nerve transfers in adult brachial plexus injuries: My methods. Hand Clin 2005;21(1):71-
82. https://doi.org/10.1016/j.hcl.2004.10.004
6. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH
(disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J
Ind Med1996;29(6):602-8. https://doi.org/10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L
7. Medical Research Council. Aids to the investigation of peripheral nerve injuries. 2nd ed. London: Her Majesty’s
Stationery Office, 1942.
8. Merrell GA, Barrie KA, Katz DL, Wolfe SW. Results of nerve transfer techniques for restoration of shoulder and
elbow function in the context of a meta-analysis of the English literature. J Hand Surg Am 2001;26(2):303-14.
https://doi.org/10.1053/jhsu.2001.21518
9. Mackinnon SE, Colbert SH. Nerve transfers for brachial plexus reconstruction. Hand Clin 2008;24(4):341-61.
https://doi.org/10.1016/j.hcl.2008.07.001
10. Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P, Ketmalasiri W. Nerve transfer to biceps
muscle using a part of the ulnar nerve in brachial plexus injury (upper arm type): a report of 32 cases. J Hand Surg 1998;23(4):711-6. https://doi.org/10.1016/S0363-5023(98)80059-2
11. Oberlin C. Nerve transfer to biceps muscle using a part of ulnar nerve for C5-6 avulsion of the brachial plexus—anatomical studies and report of four cases. J Hand Surg Am 1994;19(2):232-7. https://doi.org/10.1016/0363-5023(94)90011-6
12. Humphreys DB, Mackinnon SE. Nerve transfers. Oper Tech Plastic Reconstruct Surg 2002;9(3):89-99.
https://doi.org/10.1053/otpr.2003.S1071-0949(03)00057-X
13. Goubier J-N, Teboul F. Technique of the double nerve transfer to recover elbow flexion in C5, C6, or C5 to C7
brachial plexus palsy. Tech Hand Up Extrem Surg 2007;11(1):15-7. https://doi.org/10.1097/01.bth.0000248360.14448.6b
14. Ray WZ, Pet MA, Yee A, Mackinnon SE. Double fascicular nerve transfer to the biceps and brachialis muscles after brachial plexus injury: clinical outcomes in a series of 29 cases. J Neurosurg 2011;114(6):1520-8.
https://doi.org/10.3171/2011.1.JNS10810
15. Liverneaux PA, Diaz LC, Beaulieu JY, Durand S, Oberlin C. Preliminary results of double nerve transfer to restore elbow flexion in upper type brachial plexus palsies. Plast Reconstr Surg 2006;117(3):915-9.
https://doi.org/10.1097/01.prs.0000200628.15546.06
16. Carlsen BT, Kircher MF, Spinner RJ, Bishop AT, Shin AY. Comparison of single versus double nerve transfers for
elbow flexion after brachial plexus injury. Plast Reconstr Surg 2011;127(1):269-76. https://doi.org/10.1097/PRS.0b013e3181f95be7
17. Martins RS, Siqueira MG, Heise CO, Foroni L, Teixeira MJ. A prospective study comparing single and double
fascicular transfer to restore elbow flexion after brachial plexus injury. Neurosurgery 2013;72(5):709-14; discussion 714-5; quiz 715. https://doi.org/10.1227/NEU.0b013e318285c3f6