Transfer of the Radial Nerve Branch to the Extensor Carpi Radialis Brevis to the Anterior Interosseous Nerve to Reconstruct Thumb and Finger Flexion

2015 ◽  
Vol 40 (2) ◽  
pp. 323-328.e2 ◽  
Author(s):  
Jayme Augusto Bertelli
Keyword(s):  
Radial Nerve ◽  
Nerve Branch ◽  
Finger Flexion ◽  
Anterior Interosseous Nerve ◽  
Extensor Carpi Radialis

Delayed Transfer of the Extensor Carpi Radialis Brevis Branch of the Radial Nerve to the Anterior Interosseous Nerve for Restoration of Thumb and Index Finger Flexion: Case Report

2020 ◽  
Vol 81 (06) ◽  
pp. 571-574
Author(s):  
Renan Salomão ◽  
Jairo Porfírio de Oliveira ◽  
Carolina Fernandes Junger ◽  
Luiz Cezar Soares Ricardo ◽  
Carlos Roberto de Lima ◽  
...  
Keyword(s):  
Median Nerve ◽  
Radial Nerve ◽  
Spontaneous Recovery ◽  
Index Finger ◽  
Upper Extremities ◽  
Nerve Branch ◽  
Finger Flexion ◽  
Anterior Interosseous Nerve ◽  
Extensor Carpi Radialis ◽  
High Median

AbstractHigh median nerve injuries (HMNIs) are rare lesions involving the upper extremities and affect the median nerve from its origin to the emergence of the anterior interosseous nerve (AIN). Proximal reconstruction has long been considered the gold standard in treating HMNI, but thumb and index flexion and pinch and grip weakness are consistently not recovered. We report the surgical results of a patient affected by an HMNI with partial spontaneous recovery after a gunshot wound. AIN function was successfully restored in a delayed fashion by transferring the radial nerve branch to the extensor carpi radialis brevis to the AIN.

Innervation of the interphalangeal joint of the thumb: anatomical study

2018 ◽  
Vol 43 (6) ◽  
pp. 631-634 ◽  
Author(s):  
Ezequiel E. Zaidenberg ◽  
Dante Palumbo ◽  
Ezequiel Martinez ◽  
Martin Pastrana ◽  
Efrain Farias Cisneros ◽  
...  
Keyword(s):  
Radial Nerve ◽  
Sensory Nerve ◽  
Anatomical Study ◽  
Joint Capsule ◽  
Interphalangeal Joint ◽  
Consistent Pattern ◽  
Nerve Branch ◽  
Anatomical Basis

We dissected 30 cadaveric thumb interphalangeal joints to delineate the sensory nerve anatomy of its capsule. Four articular branches supplying the interphalangeal joint capsule of the thumb were found in all specimens. Ulnar and radial proper digital nerves provide one palmar capsular nerve branch on their respective sides. Of the two dorsal branches of the radial nerve at the dorsum of the thumb, we observed that each nerve provided one branch to the interphalangeal dorsal capsule. Our findings demonstrate a consistent pattern of innervation and may provide the anatomical basis to the treating surgeon for an effective and safe denervation of the interphalangeal joint of the thumb.

Transfer of the Distal Anterior Interosseous Nerve for Thumb Motion Reconstruction in Radial Nerve Paralysis

2020 ◽  
Vol 45 (9) ◽  
pp. 877.e1-877.e10
Author(s):  
Jayme Augusto Bertelli ◽  
Sushil Nehete ◽  
Elisa Cristiana Winkelmann Duarte ◽  
Marcos Flávio Ghizoni
Keyword(s):  
Radial Nerve ◽  
Motion Reconstruction ◽  
Nerve Paralysis ◽  
Anterior Interosseous Nerve ◽  
Thumb Motion

scholarly journals Median to radial nerve transfer after traumatic radial nerve avulsion in a pediatric patient

2019 ◽  
Vol 24 (2) ◽  
pp. 209-214 ◽  
Author(s):  
Ellen L. Larson ◽  
Katherine B. Santosa ◽  
Susan E. Mackinnon ◽  
Alison K. Snyder-Warwick
Keyword(s):  
Pediatric Patient ◽  
Radial Nerve ◽  
Sensory Nerve ◽  
Nerve Transfer ◽  
Orthopedic Procedures ◽  
Pronator Teres ◽  
Nerve Transfers ◽  
Muscle Groups ◽  
Flexor Digitorum ◽  
Extensor Carpi Radialis

This case report describes an isolated radial nerve avulsion in a pediatric patient, treated by combination sensory and motor median to radial nerve transfers. After traumatic avulsion of the proximal radial nerve, a 12-year-old male patient underwent end-to-end transfer of median nerve branches to flexor carpi radialis and flexor digitorum superficialis to the posterior interosseous nerve and extensor carpi radialis nerve, respectively. He underwent end-to-side sensory transfer of the superficial radial sensory to the median sensory nerve. Pronator teres to extensor carpi radialis brevis tendon transfer was simultaneously performed to power short-term wrist extension. Within months after surgery, the patient had regained 9–10/10 sensation in the hand and forearm. In the following months and years, he regained dexterity, independent fine-finger and thumb motions, and 4–5/5 strength in all extensors except the abductor pollicis longus muscle. He grew 25 cm without extremity deformity or need for secondary orthopedic procedures. In appropriate adult and pediatric patients with proximal radial nerve injuries, nerve transfers have advantages over tendon transfers, including restored independent fine finger motions, regained sensation, and reinnervation of multiple muscle groups with minimal donor sacrifice.

Pronator Teres Branch Transfer to the Anterior Interosseous Nerve for Treating C8T1 Brachial Plexus Avulsion

Neurosurgery ◽  
2014 ◽  
Vol 75 (4) ◽  
pp. 375-379 ◽  
Author(s):  
Jianyun Yang ◽  
Xiaotian Jia ◽  
Cong Yu ◽  
YuDong Gu
Keyword(s):  
Range Of Motion ◽  
Lateral Condyle ◽  
Main Trunk ◽  
Medial Condyle ◽  
Pronator Teres ◽  
Finger Flexion ◽  
Active Range Of Motion ◽  
Anterior Interosseous Nerve ◽  
The Mean ◽  
Finger Flexor Muscles

Abstract BACKGROUND: The treatment of C8T1 avulsion is challenging for neurosurgeons. Various methods for the restoration of finger flexion are used. However, most of these methods have different disadvantages and cannot restore the full active range of motion of the fingers. OBJECTIVE: To determine the feasibility of the pronator teres branch transfer to the anterior interosseous nerve with anatomic study and to use this method in 1 case. METHODS: The upper limbs of 15 fresh cadavers were dissected to identify the main trunk of the median nerve, the pronator teres branch, and the anterior interosseous nerve. The mean number and length of the pronator teres branches were recorded. The anterior interosseous nerve was dissected atraumatically to the most proximal level where the fibers of the anterior interosseous nerve did not mingle with the fibers of the main trunk of the median, which was defined as the atraumatic level of the anterior interosseous nerve. A line joining the most protruding point of the medial condyle and lateral condyle of the humerus was used as a measurement landmark. Pronator teres branch transfer to the anterior interosseous nerve was performed in 1 patient with C8T1 avulsion. RESULTS: The mean number of the pronator teres branches was 2.37 ± 0.49. The mean length of the pronator teres branches was 9.64 ± 0.71 mm. The mean distance between the point where the pronator teres branches originated and the landmark line was 3.87 ± 0.34 mm. The mean distance between the atraumatic level of the anterior interosseous nerve and the landmark line was −5.46 ± 0.73 mm. Transfer of the pronator teres was used to innervate the anterior interosseous nerve in 1 patient with C8T1 avulsion. When assessed 14 months after the operation, a full active range of motion of the fingers had been restored, and the patient's finger flexor muscles had regained grade 4 power. CONCLUSION: The pronator teres can be transferred to the anterior interosseous nerve directly at the elbow level. This operation was performed successfully in 1 patient, who exhibited finger flexion recovery.

Repair of a median nerve transection injury using multiple nerve transfers, with long-term functional recovery

2012 ◽  
Vol 117 (5) ◽  
pp. 886-889 ◽  
Author(s):  
Rory K. J. Murphy ◽  
Wilson Z. Ray ◽  
Susan E. Mackinnon
Keyword(s):  
Median Nerve ◽  
Motor Function ◽  
Hand Function ◽  
Nerve Transfers ◽  
Anterior Interosseous Nerve ◽  
Long Term Follow Up ◽  
Pain Symptoms ◽  
Extensor Carpi Radialis

Complete loss of median nerve motor function is a rare but devastating injury. Loss of median motor hand function and upper-extremity pronation can significantly impact a patient's ability to perform many activities of daily living independently. The authors report the long-term follow-up in a case of median nerve motor fiber transection that occurred during an arthroscopic elbow procedure, which was then treated with multiple nerve transfers. Motor reconstruction used the nerves to the supinator and extensor carpi radialis brevis to transfer to the anterior interosseous nerve and pronator. Sensory sensation was restored using the lateral antebrachial cutaneous (LABC) nerve to transfer to a portion of the sensory component of the median nerve, and a second cable of LABC nerve as a direct median nerve sensory graft. The patient ultimately recovered near normal motor function of the median nerve, but had persistent pain symptoms 4 years postinjury.

Functional restoration after early tendon transfer in high radial nerve paralysis

2010 ◽  
Vol 36 (2) ◽  
pp. 135-140 ◽  
Author(s):  
V. Dabas ◽  
T. Suri ◽  
P. K. Surapuraju ◽  
S. Sural ◽  
A. Dhal
Keyword(s):  
Radial Nerve ◽  
Tendon Transfer ◽  
Hand Function ◽  
Precision Grip ◽  
Functional Restoration ◽  
Nerve Paralysis ◽  
Power Grip ◽  
Pronator Teres ◽  
Junction Site ◽  
Extensor Carpi Radialis

We assessed the effect of an early transfer of pronator teres to extensor carpi radialis brevis on hand function in patients with high radial nerve paralysis. Power grip and precision grip were measured preoperatively and postoperatively using a dynamometer. Fifteen patients were operated on, of which ten could be assessed at the end of 6 months. At 6 months after surgery, there was a median increase of 48% in power grip, 162% in tip pinch, 90% in key pinch and 98% in palmar pinch. Decreased palmar flexion was seen in four patients. Fraying of the periosteal extension and rupture of sutures at the junction site were each seen in one patient, leading to unsatisfactory results. Early tendon transfer quickly restored efficient grip while awaiting reinnervation of wrist extensors, avoiding the need for prolonged external splintage.

The Innervation Pattern of the Radial Nerve at the Elbow and in the Forearm

1998 ◽  
Vol 23 (2) ◽  
pp. 167-169 ◽  
Author(s):  
G. BRANOVACKI ◽  
M. HANSON ◽  
R. CASH ◽  
M. GONZALEZ
Keyword(s):  
Radial Nerve ◽  
Sensory Nerve ◽  
Extensor Digitorum ◽  
Sensory Nerves ◽  
Posterior Interosseous Nerve ◽  
Extensor Pollicis Longus ◽  
Abductor Pollicis Longus ◽  
Extensor Carpi Ulnaris ◽  
Wide Variability ◽  
Extensor Carpi Radialis

Sixty paired cadaver forearms were dissected to examine the distribution of the radial nerve branches to the muscles at the elbow and forearm. Emphasis was placed on the innervation of the extensor carpi radialis brevis and the supinator muscles because of discrepancies in the literature concerning these muscles. The most common branching pattern (from proximal to distal) was to brachioradialis, extensor carpi radialis longus, superficial sensory, extensor carpi radialis brevis, supinator, extensor digitorum/extensor carpi ulnaris, extensor digiti minimi, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus and extensor indicis. The branch to extensor digitorum and extensor carpi ulnaris came off as a common stem often with the branch to extensor digiti minimi. The branch to the ECRB muscle was noted to arise from the posterior interosseous nerve in 45%, superficial sensory nerve in 25% and at the bifurcation of the posterior interosseous and superficial sensory nerves in 30% of specimens. The supinator had an average of 2.3 branches from the posterior interosseous nerve (range 1–6). The branches to the supinator showed a wide variability proximal to and within the supinator.

Resistant Tennis Elbow

1984 ◽  
Vol 9 (1) ◽  
pp. 64-66 ◽  
Author(s):  
G. H. HEYSE-MOORE
Keyword(s):  
Radial Nerve ◽  
Tennis Elbow ◽  
Anatomical Study ◽  
Nerve Entrapment ◽  
Posterior Interosseous Nerve ◽  
Lateral Epicondyle ◽  
Adjacent Structures ◽  
Extensor Carpi Radialis ◽  
Symptoms And Signs ◽  
Results Of Surgery

Fifty cases of resistant tennis elbow were studied, thirty seven of these had been treated by lengthening the tendon of extensor carpi radialis brevis, and thirteen by decompression of the radial tunnel. The two groups were well matched in terms of age, sex and pre-operative symptoms and signs. It was found that the results of surgery were very similar in the two groups and this observation is explained by anatomical study showing that surgical division of the fibrous arch of the superficial leaf of supinator will relieve tension on the lateral epicondyle and its adjacent structures thus allowing relief of symptoms independently of radial or posterior interosseous nerve decompression. This elaborates previously published work showing that there is no clinical or electrical evidence of radial nerve entrapment in resistant tennis elbow.

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