Nerve Transfer to the Median Nerve Using Parts of the Ulnar and Radial Nerves in the Rabbit – Effects on Motor Recovery of the Median Nerve and Donor Nerve Morbidity

2000 ◽  
Vol 25 (4) ◽  
pp. 329-335 ◽  
Author(s):  
B. S. LUTZ ◽  
D. C. C. CHUANG ◽  
S. S. CHUANG ◽  
J. C. HSU ◽  
S. F. MA ◽  
...  
Keyword(s):  
Muscle Contraction ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Radial Nerve ◽  
Muscle Power ◽  
Donor Site ◽  
Nerve Transfer ◽  
Donor Site Morbidity ◽  
Motor Recovery ◽  
Contraction Force

In this study, motor re-innervation of the median nerve by transfer of one-third, one-half, and two-thirds of either the agonistic ulnar nerve or the antagonistic radial nerve was investigated in both extremities of 20 rabbits. Recipient median nerve: Muscle contraction force of the flexor digitorum sublimus muscle after a one-third and a one-half of the ulnar nerve transfer achieved an average of 75 and 97% muscle power respectively as compared to conventional end-to-end neurorrhaphy. Muscle contraction force after one-third or one-half of the radial nerve transfer was significantly lower (36%). Donor nerves: Extensor carpi radialis muscle or flexor carpi ulnaris muscle contraction force 6 months postoperatively demonstrated a significant decrease after a one-half ulnar nerve and a two-thirds ulnar or radial nerve transfer, but not after a one-third transfer of either radial or ulnar nerves. Histologically, the number of axons in the re-innervated median nerve and both donor nerves distal to the coaptation site seemed to follow variable patterns. It was concluded that in the rabbit use of one-third of the agonistic ulnar nerve for re-innervation of the median nerve results in useful motor recovery with negligible donor site morbidity. Clinically, this technique may offer an alternative option for proximal nerve injuries or for free functioning muscle transplantations.

scholarly journals Sensory Nerve Transfer for Lower Roots Brachial Plexus Injury: Superficial Radial Nerve to the Dorsal Cutaneous Branch and the Superficial Branch of the Ulnar Nerve

2019 ◽  
Vol 11 (03) ◽  
pp. 178-180
Author(s):  
Feiran Wu ◽  
Chye Yew Ng
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Radial Nerve ◽  
Brachial Plexus Injury ◽  
Donor Site ◽  
Sensory Nerve ◽  
Nerve Transfer ◽  
Superficial Radial Nerve ◽  
Superficial Branch ◽  
Cutaneous Branch

AbstractIn the treatment of brachial plexus injury to lower nerve roots, the priority is to restore motor function to the paralyzed hand. In addition, it is also important to consider sensory reconstruction, which is crucial to the optimal restoration of prehensile function. We report the surgical technique and sensory recovery of a nerve transfer in a case in which the superficial radial nerve was transferred to the dorsal cutaneous branch and the superficial branch of the ulnar nerve in a patient with C7, C8, and T1 roots injury. The nerve transfer successfully restored sensation in the ulnar one and a half digits as well as the ulnar border of the hand, with minimal donor site deficit. This technique provides a useful sensory reconstructive option in patients with brachial plexus injury to lower roots.

Transfer of a Motor Fascicle From the Ulnar Nerve to the Branch of the Radial Nerve Destined to the Long Head of the Triceps for Restoration of Elbow Extension in Brachial Plexus Surgery

Neurosurgery ◽  
2011 ◽  
Vol 70 (2) ◽  
pp. E516-E520 ◽  
Author(s):  
Leandro Pretto Flores
Keyword(s):  
Computed Tomography ◽  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Radial Nerve ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Elbow Extension ◽  
Long Head ◽  
Brachial Plexus Surgery

Abstract BACKGROUND AND IMPORTANCE: Restoration of elbow extension has not been considered of much importance regarding functional outcomes in brachial plexus surgery; however, the flexion of the elbow joint is only fully effective if the motion can be stabilized, what can be achieved solely if the triceps brachii is coactivated. To present a novel nerve transfer of a healthy motor fascicle from the ulnar nerve to the nerve of the long head of the triceps to restore the elbow extension function in brachial plexus injuries involving the upper and middle trunks. CLINICAL PRESENTATION: Case 1 is a 32-year-old man sustaining a right brachial extended upper plexus injury in a motorcycle accident 5 months before admission. The computed tomography myelogram demonstrated avulsion of the C5 and C6 roots. Case 2 is a 24-year-old man who sustained a C5-C7 injury to the left brachial plexus in a traffic accident 4 months before admission. Computed tomography myelogram demonstrated signs of C6 and C7 root avulsion. The technique included an incision at the medial border of the biceps, in the proximal third of the involved arm, followed by identification of the ulnar nerve, the radial nerve, and the branch to the long head of the triceps. The proximal stump of a motor fascicle from the ulnar nerve was sutured directly to the distal stump of the nerve of the long head of the triceps. Techniques to restore elbow flexion and shoulder abduction were applied in both cases. Triceps strength Medical Research Council M4 grade was obtained in both cases. CONCLUSION: The attempted nerve transfer was effective for restoration of elbow extension in primary brachial plexus surgery; however, it should be selected only for cases in which other reliable donor nerves were used to restore elbow flexion.

Corneal neurotisation by great auricular nerve transfer and scleral-corneal tunnel incisions for neurotrophic keratopathy

2018 ◽  
Vol 103 (9) ◽  
pp. 1235-1238 ◽  
Author(s):  
Nate Jowett ◽  
Roberto Pineda II
Keyword(s):  
Visual Acuity ◽  
Confocal Microscopy ◽  
Donor Site ◽  
Nerve Transfer ◽  
Donor Site Morbidity ◽  
Nerve Fibres ◽  
Novel Technique ◽  
Great Auricular Nerve ◽  
Early Results ◽  
Neurotrophic Keratopathy

Background/AimsMedical management of neurotrophickeratopathy is challenging and costly. Supra-orbital nerve transfer to thecornea has proven effective for management of keratopathy, but yieldsconsiderable donor site morbidity. Herein, a novel technique for reinnervationof the anaesthetic cornea is presented and early results characterised.MethodsSensory fibres of the ipsilateral greatauricular nerve were directed via an interposition graft to the anteriorcorneal stroma using scleral-corneal tunnel incisions in two patients withgrade III neurotrophic keratopathy.ResultsImprovements in visual acuity, cornealpachymetry, corneal esthesiometry, and corneal neurotisation as assessed by invivo confocal microscopy were observed within nine months of surgery in bothpatients.ConclusionCorneal neurotisation by interposition grafttransfer of great auricular nerve fibres via scleral-corneal tunnel incisionsappears effective in the management of neurotrophic keratopathy.

Distal nerve transfer from the median nerve lumbrical fibers to the distal ulnar nerve motor branches in the palm: An anatomical cadaveric study

Microsurgery ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 434-440
Author(s):  
Michele R. Colonna ◽  
Davide Pino ◽  
Bruno Battiston ◽  
Francesco Stagno d'Alcontres ◽  
Konstantinos Natsis ◽  
...  
Keyword(s):  
Median Nerve ◽  
Ulnar Nerve ◽  
Nerve Transfer ◽  
Cadaveric Study ◽  
Distal Nerve

Tubular Repair of the Median Nerve in the Human Forearm

1994 ◽  
Vol 19 (3) ◽  
pp. 273-276 ◽  
Author(s):  
G. LUNDBORG ◽  
B. ROSÉN ◽  
S. O. ABRAHAMSON ◽  
L. DAHLIN ◽  
N. DANIELSEN
Keyword(s):  
Muscle Contraction ◽  
Median Nerve ◽  
Hand Function ◽  
Nerve Trunk ◽  
Contraction Force ◽  
Silicone Tube ◽  
Human Forearm ◽  
Normal Hand ◽  
Male Patients ◽  
Chamber Technique

Transected median nerves in the forearm of two male patients, 12 and 21 years of age, were treated with a chamber technique leaving a 3 to 5 mm gap between the nerve ends. The nerve ends were enclosed in a silicone tube of such a dimension that would not cause compression of the nerve. Post-operative examination including sensory evaluation and assessment of muscle contraction force was carried out after 3 years. In both cases there was excellent motor recovery of the thenar muscles. Outgrowth of sensory fibres was remarkably fast, resulting ultimately in functional sensibility allowing almost normal hand function. 2PD was ⩽ 6 mm (12year-old patient) and 8 to 10 mm (21-year-old patient) respectively. In one case the silicone tube was re-explored because of minor local discomfort 2 years after the repair. The former gap was bridged by a smooth continuous nerve-like structure of the same diameter as the adjacent nerve trunk and with no signs of nenroma formation or compression of the nerve.

Elbow flexion strength and contractile activity after partial ulnar nerve or intercostal nerve transfers for brachial plexus injuries

2020 ◽  
Vol 45 (8) ◽  
pp. 818-826
Author(s):  
Dawn Sinn Yii Chia ◽  
Kazuteru Doi ◽  
Yasunori Hattori ◽  
Sotetsu Sakamoto
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Muscle Power ◽  
Contractile Activity ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Intercostal Nerve ◽  
Nerve Transfers ◽  
Forearm Muscles ◽  
Flexion Strength

We compared the outcomes of 23 partial ulnar nerve and 15 intercostal nerve transfers for elbow flexion reconstruction in patients with C56 or C567 brachial plexus injuries using manual muscle power, dynamometric measurements of elbow flexion strength and electromyography. The range of elbow flexion and muscle strength recovery to Grade 3 or 4 were comparable between the two groups. The patients with C567 injuries had significantly stronger eccentric contraction after the partial ulnar nerve transfer than after the intercostal nerve transfer ( p < 0.05). Electromyography of individual muscles demonstrated that the patients with partial ulnar nerve transfers were unable to voluntarily isolate biceps contraction and recruited forearm flexors and extensors. The patients after partial ulnar nerve transfer had significantly more activity of the forearm muscles during concentric elbow flexion than after intercostal nerve transfers ( p < 0.05). We conclude that partial ulnar nerve transfers were superior to intercostal nerve transfers when assessed quantitatively with the dynamometer to evaluate elbow flexion, although simultaneous recruitment of forearm muscles may have contributed to the increased elbow flexion strength in the patients with the partial ulnar nerve transfer. Level of evidence: III

Peripheral Nervous SystemUpper Extremity

2013 ◽  
Author(s):  
Adam Fisch
Keyword(s):  
Nervous System ◽  
Brachial Plexus ◽  
Median Nerve ◽  
Peripheral Nervous System ◽  
Ulnar Nerve ◽  
Radial Nerve ◽  
Upper Extremities ◽  
Cervical Plexus

Chapter 3 discusses how to draw the peripheral nervous system (upper extremities), including the brachial plexus, median nerve, ulnar nerve, radial nerve, and the cervical plexus.

Emergence of Radial Nerve Dominance in Median Nerve Cortex After Median Nerve Transection in an Adult Squirrel Monkey

1997 ◽  
Vol 77 (1) ◽  
pp. 522-526 ◽  
Author(s):  
C. E. Schroeder ◽  
S. Seto ◽  
P. E. Garraghty
Keyword(s):  
Median Nerve ◽  
Squirrel Monkey ◽  
Ulnar Nerve ◽  
Action Potentials ◽  
Radial Nerve ◽  
Current Source ◽  
Short Latency ◽  
Nerve Transection ◽  
A Site ◽  
Stimulation Of

Schroeder, C. E., S. Seto, and P. E. Garraghty. Emergence of radial nerve dominance in median nerve cortex after median nerve transection in an adult squirrel monkey. J. Neurophysiol. 77: 522–526, 1997. Throughout the glabrous representation in Area 3b, electrical stimulation of the dominant (median or ulnar) input produces robust, short-latency excitation, evident as a net extracellular “sink” in the Lamina 4 current source density (CSD) accompanied by action potentials. Stimulation of the collocated nondominant (radial nerve) input produces a subtle short-latency response in the Lamina 4 CSD unaccompanied by action potentials and followed by a clear excitatory response 12–15 ms later. Laminar response profiles for both inputs have a “feedforward” pattern, with initial activation in Lamina 4, followed by extragranular laminae. Such corepresentation of nondominant radial nerve inputs with the dominant (median or ulnar nerve) inputs in the glabrous hand surface representation provides a likely mechanism for reorganization after median nerve section in adult primates. To investigate this, we conducted repeated recordings using an implanted linear multi-electrode array straddling the cortical laminae at a site in “median nerve cortex” (i.e., at a site with a cutaneous receptive field on the volar surface of D2 and thus with its dominant afferent input conveyed by the median nerve) in an adult squirrel monkey. We characterized the baseline responses to median, radial, and ulnar nerve stimulation. We then cut the median nerve and semi-chronically monitored radial nerve, ulnar nerve and median nerve (proximal stump) evoked responses. The radial nerve response in median nerve cortex changed progressively during the weeks after median nerve transection, ultimately assuming the characteristics of the dominant nerve profile. During this time, median, and ulnar nerve profiles displayed little or no change.

scholarly journals Topographical, anatomical and neurosurgical aspects of "end-to-side" nerve repair

2021 ◽  
Vol 23 (1) ◽  
pp. 121-128
Author(s):  
A. Y. Nisht ◽  
Nikolay F. Fomin ◽  
Vladimir P. Orlov
Keyword(s):  
Median Nerve ◽  
Ulnar Nerve ◽  
Lateral Surface ◽  
Peripheral Nerves ◽  
Radial Nerve ◽  
Surgical Techniques ◽  
Nerve Fibers ◽  
Individual Variability ◽  
Motor Branch ◽  
Deep Branch

The article presents the results of a comprehensive anatomical and experimental study of individual variability in the structure and topography of motor branches of peripheral nerves in relation to the justification of methods for selective reinnervation of tissues by the "end-to-side" neurorrhaphy. It was found that relatively longer branches of peripheral nerves with a small number of connecting inter-arm collaterals characteristic of narrow and long limbs create conditions for less traumatic mobilization of motor branches. In cases with relatively wide and short extremities mobilization of peripheral nerves is complicated by the presence of a large number of collateral branches and intra-trunk connections, which are often damaged when separate bundles that make up the mobilized branches of the donor or recipient nerve are isolated from the main nerve trunk. It has been shown that potential recipient nerves should be motor branches of peripheral nerves, the preservation of which is of fundamental importance for the function of the corresponding segment of the limb. To create conditions conducive to selective reinnervation of functionally significant muscle groups of the upper limb, we have developed, justified from anatomical positions, and tested in an experiment on anatomical material methods for connecting the distal motor branches of peripheral nerves by the "end-to-side" neurorrhaphy. The main idea of accelerated recovery of the thumb opposition in injuries of the median nerve is to reinnervate the muscles of the elevation of the I finger due to nerve fibers that are part of the deep branch of the ulnar nerve. For this purpose, surgical techniques have been developed for connecting the recurrent motor branch of the damaged median nerve mobilized at the level of the wrist with the edges of a surgically formed perineurium defect on the lateral surface of the bundles that make up the deep branch of the ulnar nerve. In another clinical situation, in patients with radial nerve injuries, for the muscle reinnervation, а method is proposed for neurotisation of the deep motor branch of the radial nerve by the end-to-side suture to the lateral surface of the median nerve. We assume that performing the "end-to-side" nerve suture at the level of the base of the hand in the cases of proximal damage to the median nerve will reduce the time of reinnervation of the muscles of the thumb elevation by 400450 days. Transposition of the deep branch of the damaged at the proximal level radial nerve with "end-to-side" neurorrhaphy to the median nerve by 250300 days (based on the total length of the shoulder and forearm, which is about 50 cm and the rate of regeneration of nerve fibers 1 mm per day). Accordingly, with higher injuries (brachial plexus), the gain in the time of reinnervation of the distal segments will be even greater. In our opinion, the results can be used as a basis for further clinical research on the development of methods for selective tissue reinnervation in cases with isolated injuries of the peripheral nerves.

Restoration of Elbow Flexion in Traumatic Upper Brachial Plexus Palsy in Adults: Outcome with Intraplexus Distal Nerve Transfers in 78 Patients

2018 ◽  
Vol 37 (04) ◽  
pp. 285-290
Author(s):  
Mario Siqueira ◽  
Roberto Martins ◽  
Wilson Faglioni Junior ◽  
Luciano Foroni ◽  
Carlos Heise
Keyword(s):  
Brachial Plexus ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Traumatic Injury ◽  
Surgical Techniques ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Nerve Transfers ◽  
Significant Difference ◽  
Distal Nerve

Objective To present the functional outcomes of distal nerve transfer techniques for restoration of elbow flexion after upper brachial plexus injury. Method The files of 78 adult patients with C5, C6, ± C7 lesions were reviewed. The attempt to restore elbow flexion was made by intraplexus distal nerve transfers using a fascicle of the ulnar nerve (group A, n = 43), or a fascicle of the median nerve (group B, n = 16) or a combination of both (group C, n = 19). The result of the treatment was defined based on the British Medical Research Council grading system: muscle strength < M3 was considered a poor result. Results The global incidence of good/excellent results with these nerve transfers was 80.7%, and for different surgical techniques (groups A, B, C), it was 86%, 56.2% and 100% respectively. Patients submitted to ulnar nerve transfer or double transfer (ulnar + median fascicles transfer) had a better outcome than those submitted to median nerve transfer alone (p < 0.05). There was no significant difference between the outcome of ulnar transfer and double transfer. Conclusion In cases of traumatic injury of the upper brachial plexus, good and excelent results in the restoration of elbow flexion can be obtained using distal nerve transfers.

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