The effects of denervation, reinnervation, and muscle imbalance on functional muscle length and elbow flexion contracture following neonatal brachial plexus injury

Background: Partial ulnar nerve transfer to the biceps motor branch of the musculocutaneous nerve (Oberlin’s transfer) is a successful approach to restore elbow flexion in patients with upper brachial plexus injury (BPI). However, there is no report on more than 10 years subjective and objective outcomes. The purpose of this study was to clarify the long-term outcomes of Oberlin’s transfer based on the objective evaluation of elbow flexion strength and subjective functional evaluation of patients. Methods: Six patients with BPI who underwent Oberlin’s transfer were reviewed retrospectively by their medical records. The mean age at surgery was 29.5 years, and the mean follow-up duration was 13 years. The objective functional outcomes were evaluated by biceps muscle strength using the Medical Research Council (MRC) grade at preoperative, postoperative, and final follow-up. The patient-derived subjective functional outcomes were evaluated using the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at final follow-up. Results: All patients had MRC grade 0 (M0) or 1 (M1) elbow flexion strength before operation. Four patients gained M4 postoperatively and maintained or increased muscle strength at the final follow-up. One patient gained M3 postoperatively and at the final follow-up. Although one patient achieved M4 postoperatively, the strength was reduced to M2 due to additional disorder. The mean score of QuickDASH was 36.5 (range, 7–71). Patients were divided into two groups; three patients had lower scores and the other three patients had higher scores of QuickDASH. Conclusions: Oberlin’s transfer is effective in the restoration of elbow flexion and can maintain the strength for more than 10 years. Patients with upper BPI with restored elbow flexion strength and no complicated nerve disorders have over ten-year subjective satisfaction.

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Is one nerve transfer enough? A systematic review and pooled analysis comparing ulnar fascicular nerve transfer and double ulnar and median fascicular nerve transfer for restoration of elbow flexion after traumatic brachial plexus injury

Microsurgery ◽

10.1002/micr.30536 ◽

2019 ◽

Vol 40 (3) ◽

pp. 361-369 ◽

Cited By ~ 1

Author(s):

Megan R. Donnelly ◽

Kevin T. Rezzadeh ◽

Dorice Vieira ◽

David Daar ◽

Jacques Hacquebord

Keyword(s):

Systematic Review ◽

Brachial Plexus ◽

Brachial Plexus Injury ◽

Nerve Transfer ◽

Elbow Flexion ◽

Pooled Analysis

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Restoration of elbow flexion in adult traumatic brachial plexus injury – a quantitative analysis of results of single versus double nerve transfer

Injury ◽

10.1016/j.injury.2020.10.090 ◽

2020 ◽

Author(s):

George Mathew Srampickal ◽

Anil Mathew ◽

Sreekanth Raveendran ◽

Bijesh Kumar Yadav ◽

Binu Prathap Thomas

Keyword(s):

Quantitative Analysis ◽

Brachial Plexus ◽

Brachial Plexus Injury ◽

Nerve Transfer ◽

Elbow Flexion ◽

Analysis Of Results ◽

Single Versus

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Correlation of compound muscle action potential generated by donor nerves with the recovery of elbow flexion in Oberlin transfer in brachial plexus injury

Indian Journal of Plastic Surgery ◽

10.4103/ijps.ijps_31_17 ◽

2018 ◽

Vol 51 (02) ◽

pp. 137-144

Author(s):

Mukund Ramchandra Thatte ◽

Binita Bharat Raut ◽

Amita Shivyogi Hiremath ◽

Sushil Ramesh Nehete ◽

Nayana Somala Nayak

Keyword(s):

Action Potential ◽

Brachial Plexus ◽

Brachial Plexus Injury ◽

Compound Muscle Action Potential ◽

Nerve Transfer ◽

Elbow Flexion ◽

Muscle Action ◽

Muscle Action Potential ◽

Group A ◽

Group B

ABSTRACT Objective: To study the correlation of compound muscle action potential of donor nerves with the recovery of elbow flexion in Oberlin transfer in brachial plexus injury. Introduction: Distal nerve transfer using motor fascicle of ulnar or median nerve to restore elbow flexion is a part of reconstructive surgery after upper brachial plexus injury, first described by Oberlin et al. However, one of the most critical influences on functional outcome is number of functioning motor axons in donor fascicle which is reflected by its compound muscle action potential. We studied whether nerve transfers with donor nerves showing higher amplitudes will yield better reinnervation of muscle and therefore better function as estimated by clinical examination. Methods: We prospectively studied 30 cases of upper brachial plexus injury, of which were treated with Oberlin transfer using ulnar or median or both nerves. The prerequisites were no elbow flexion and hand and wrist flexors showing the power of more than Medical research Council MRC Grade 4. Donor nerves selected either ulnar or median having CMAP >4 mv in our electrophysiology laboratory during nerve conduction study. Patients were followed up for 1 year and assessed clinically for restoration of elbow flexion, weight tolerance. Results: A total of 30 patients of Oberlin transfer were evaluated for improvement power of biceps and elbow flexion. (MRC) grading was done at 1 year. Twenty-seven patients had a good result (MRC grade ≥3), i.e., 90% of patients. Based on the MRC grades, we categorised the patients into two groups as follows: Group A and Group B. Group A included patients with MRC Grade 4–5 and Group B included Grades 3–3.5. We tried to establish a correlation between CMAP and MRC scores by comparison of MRC grade patients for their pre CMAPs which revealed a statistically significant higher CMAPs between the groups. (Mann–Whitney U-test, P = 0.028). This indicates the association of higher pre-CMAPs with higher MRC grades. Conclusion: We conclude that higher the compound muscle action potential of donor nerves, better the recovery of elbow flexion in Oberlin transfer in brachial plexus injury.

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