Surgical Anatomy of the Radial Nerve at the Elbow and in the Forearm: Anatomical Basis for Intraplexus Nerve Transfer to Reconstruct Thumb and Finger Extension in C7 − T1 Brachial Plexus Palsy

2016 ◽  
Vol 32 (09) ◽  
pp. 670-674 ◽  
Author(s):  
Lei Zhang ◽  
Chun-Lin Zhang ◽  
Yu-Dong Gu ◽  
Zhen Dong
Keyword(s):  
Brachial Plexus ◽  
Radial Nerve ◽  
Nerve Transfer ◽  
Surgical Anatomy ◽  
Brachial Plexus Palsy ◽  
Finger Extension ◽  
Anatomical Basis

Outcomes of Transferring a Healthy Motor Fascicle From the Radial Nerve to a Branch for the Triceps to Recover Elbow Extension in Partial Brachial Plexus Palsy

Neurosurgery ◽  
2016 ◽  
Vol 80 (3) ◽  
pp. 448-453 ◽  
Author(s):  
Leandro Pretto Flores
Keyword(s):  
Retrospective Study ◽  
Brachial Plexus ◽  
Radial Nerve ◽  
Surgical Planning ◽  
Safe Procedure ◽  
Elbow Extension ◽  
Brachial Plexus Palsy ◽  
Finger Extension ◽  
Important Objective ◽  
Lateral Head

Abstract BACKGROUND: Triceps reinnervation is an important objective to pursue when repairing the brachial plexus for cases with upper roots injuries, and a number of different techniques have been developed in order to restore elbow extension in such cases. OBJECTIVE: To demonstrate the surgical outcomes associated with the technique of transferring a single healthy motor fascicle from the radial nerve of the affected arm to a branch innervating 1 of the 3 heads of the triceps. METHODS: A retrospective study of 13 adult patients sustaining an upper trunk syndrome associated with total elbow extension palsy who underwent the proposed technique as part of the surgical planning for reconstruction of the brachial plexus. RESULTS: Outcomes scored as M4 for elbow extension were noted in 9 cases (70%), M3 in 3 (23%), and M1 in 1 subject (7%). No patient considered the postoperative strength for carpal or finger extension as impaired. There were no differences in outcomes by using a fascicle activating carpal or finger extension as donor, as well as regarding the use of the branch to the medial or lateral head of the triceps as the recipient. CONCLUSION: The technique of transferring a healthy motor fascicle from the radial nerve of the affected side to one of its nonfunctional motor branches to the triceps is an effective and safe procedure for recovering elbow extension function in patients sustaining partial injuries of the brachial plexus.

Transfer of the phrenic nerve to the posterior division of the lower trunk to recover thumb and finger extension in brachial plexus palsy

2011 ◽  
Vol 114 (1) ◽  
pp. 212-216 ◽  
Author(s):  
Haodong Lin ◽  
Chunlin Hou ◽  
Aimin Chen ◽  
Zhen Xu
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Nerve Transfer ◽  
Brachial Plexus Palsy ◽  
Lower Trunk ◽  
Finger Extension ◽  
The Mean ◽  
Posterior Division ◽  
Grade 3

Object Hand function is severely impaired in cases of lower root avulsion. In the present study, the authors investigated the clinical effectiveness and safety of phrenic nerve transfer to the posterior division of the lower trunk of the brachial plexus to recover thumb and finger extension. Methods Between 2004 and 2006, 10 patients with brachial plexus palsy underwent phrenic nerve transfer as part of a strategy for surgical reconstruction of their plexuses. The mean patient age of was 27.2 years (range 18–44 years), and the mean interval from injury to surgery was 5.7 months (range 3–9 months). The phrenic nerve was always transferred to the posterior division of the lower trunk. Results The follow-up of the patients ranged from 2.5 to 4.4 years, with an average follow-up length of 3.5 years. There were no major complications related to the surgery. Eight patients recovered to Grade 3 or better (Medical Research Council grade) in extensor digitorum strength, and 7 patients recovered to Grade 3 or better in extensor pollicis strength. None of the patients had any clinical signs or symptoms of respiratory insufficiency. Conclusions Satisfactory thumb and finger extension can be achieved by phrenic nerve transfer to the posterior division of the lower trunk of the brachial plexus. This procedure is simple and less traumatic than that of transferring the phrenic nerve to the radial nerve. It is indicated in cases in which the brachial plexus is relatively intact at the division level.

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.

Spinal to accessory nerve transfer in traumatic brachial plexus palsy: is body mass index a predictor of outcome?

2013 ◽  
Vol 156 (1) ◽  
pp. 159-163 ◽  
Author(s):  
Mariano Socolovsky ◽  
Gilda Di Masi ◽  
Gonzalo Bonilla ◽  
Martijn Malessy
Keyword(s):  
Body Mass Index ◽  
Brachial Plexus ◽  
Body Mass ◽  
Nerve Transfer ◽  
Accessory Nerve ◽  
Brachial Plexus Palsy

Hypoglossal nerve transfer in obstetric brachial plexus palsy

2006 ◽  
Vol 59 (5) ◽  
pp. 474-478 ◽  
Author(s):  
Gerhard Blaauw ◽  
Ymte Sauter ◽  
Cyrielle L.E. Lacroix ◽  
Albert C.J. Slooff
Keyword(s):  
Brachial Plexus ◽  
Hypoglossal Nerve ◽  
Nerve Transfer ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus

Anatomic study of the intercostal nerve transfer to the suprascapular nerve and a case report

2013 ◽  
Vol 39 (2) ◽  
pp. 194-198 ◽  
Author(s):  
S. Hu ◽  
B. Chu ◽  
J. Song ◽  
L. Chen
Keyword(s):  
Case Report ◽  
Brachial Plexus ◽  
External Rotation ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
Intercostal Nerve ◽  
Accessory Nerve ◽  
Shoulder Abduction ◽  
Anatomical Basis ◽  
Intercostal Nerves

The purpose of this study was to investigate the anatomical basis of intercostal nerve transfer to the suprascapular nerve and provide a case report. Thoracic walls of 30 embalmed human cadavers were used to investigate the anatomical feasibility for neurotization of the suprascapular nerve with intercostal nerves in brachial plexus root avulsions. We found that the 3rd and 4th intercostal nerves could be transferred to the suprascapular nerve without a nerve graft. Based on the anatomical study, the 3rd and 4th intercostal nerves were transferred to the suprascapular nerve via the deltopectoral approach in a 42-year-old man who had had C5-7 root avulsions and partial injury of C8, T1 of the right brachial plexus. Thirty-two months postoperatively, the patient gained 30° of shoulder abduction and 45° of external rotation. This procedure provided us with a reliable and convenient method for shoulder function reconstruction after brachial plexus root avulsion accompanied with spinal accessory nerve injury. It can also be used when the accessory nerve is intact but needs to be preserved for better shoulder stability or possible future trapezius transfer.

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