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.

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.

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 Following Resection of Malignant Peripheral Nerve Sheath Tumour of the Median Nerve: A Case Report

2020 ◽  
Vol 25 (03) ◽  
pp. 373-377
Author(s):  
Chung Ming Chan ◽  
Aymeric YT. Lim ◽  
Mark E. Puhaindran
Keyword(s):  
Peripheral Nerve ◽  
Median Nerve ◽  
Index Finger ◽  
Sensory Nerve ◽  
Functional Restoration ◽  
Flexor Digitorum Profundus ◽  
Wide Resection ◽  
Abductor Pollicis Brevis ◽  
Nerve Branch ◽  
Nerve Sheath

Management of malignant peripheral nerve sheath tumours (MPNSTs) is primarily surgical, involving surgical resection with wide margins, and frequently radiation therapy. When a MPNST involves a major peripheral nerve, wide resection leads to significant distal neurologic deficits. A patient who underwent resection of a MPNST involving the median nerve above the elbow is presented. Staged tendon and nerve transfers were performed to restore sensation to the thumb and index finger, thumb opposition and flexion, finger flexion and forearm pronation. These included: 1. radial sensory nerve branches to digital nerves of thumb and index finger, 2. ulnar nerve branch of flexor carpi ulnaris to pronator teres, 3. brachioradialis to flexor pollicis longus, 4. side-to-side transfer of flexor digitorum profundus tendon of index finger to middle, ring and little fingers, 5. extensor indicis proprius to abductor pollicis brevis. The rationale, approach, and favourable results of functional reconstruction in this patient are detailed.

The Flexor Pollicis Longus and its Relation to the Anterior and Posterior Interosseous Nerves

1998 ◽  
Vol 23 (2) ◽  
pp. 170-172 ◽  
Author(s):  
S. SHIRALI ◽  
M. HANSON ◽  
G. BRANOVACKI ◽  
M. GONZALEZ
Keyword(s):  
Median Nerve ◽  
Upper Extremities ◽  
Flexor Digitorum Profundus ◽  
Flexor Pollicis Longus ◽  
Anterior Interosseous Nerve ◽  
Flexor Digitorum

Sixty paired cadaver upper extremities were dissected to study the anatomy of the flexor pollicis longus in the forearm and its relation to the median and anterior interosseous nerves. An accessory head was noted in 33 (55%) of 60 specimens. The accessory head was noted to pass anterior to the anterior interosseous nerve in all specimens. The accessory head was noted to pass posterior to the median nerve in 57 specimens, and anterior to the nerve in three. Tendon or muscle anomalies were noted in eight specimens (13%), seven of which involved an anomalous attachment between the FPL and the flexor digitorum profundus of the index.

Median nerve branches to the pronator teres: cadaveric study with potential use in neurotization procedures to the radial nerve at the elbow

2011 ◽  
Vol 114 (1) ◽  
pp. 253-255 ◽  
Author(s):  
R. Shane Tubbs ◽  
Joshua M. Beckman ◽  
Marios Loukas ◽  
Mohammadali M. Shoja ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Median Nerve ◽  
Radial Nerve ◽  
Biceps Brachii ◽  
Cadaveric Study ◽  
Nerve Branch ◽  
Neural Connections ◽  
Pronator Teres ◽  
Cubital Fossa ◽  
The Mean ◽  
Potential Use

Object Various donor nerves have been used for brachial plexus neurotization procedures. To the authors' knowledge, neurotization of median nerve branches to the pronator teres to the radial nerve at the elbow have not been explored. Methods In an attempt to identify an additional nerve donor candidate for neurotization procedures of the upper limb, 20 cadaveric upper limbs underwent dissection of the cubital fossa and identification of branches of the median nerve to the pronator teres. Measurements were made of such branches, and distal transection was then performed to determine the appropriate length so that the structure could be brought to the laterally positioned radial nerve via tunneling deep to the biceps brachii muscle. Results All specimens were found to have a median nerve branch to the pronator teres that was long enough to reach the radial nerve in the cubital fossa. Neural connections remained tension free with full pronation and supination. The mean length of these branches to the pronator teres was 3.6 cm. The overall mean diameter of these nerves was 1.5 mm. The mean proximal, midpoint, and distal diameters were 2.0, 1.8, and 1.5 mm, respectively. The mean distance between the origin of these branches to the pronator teres and the medial epicondyle of the humerus was 4.1 cm. Conclusions Based on the results of our cadaveric study, the use of the branch of the median nerve to the pronator teres muscle may be considered for neurotization of the radial nerve in the cubital fossa.

Susceptibility of the Superficial Sensory Branch of the Radial Nerve to Form Painful Neuromas

1984 ◽  
Vol 9 (1) ◽  
pp. 42-45 ◽  
Author(s):  
A. LEE DELLON ◽  
SUSAN E. MACKINNON
Keyword(s):  
Median Nerve ◽  
Ulnar Nerve ◽  
Radial Nerve ◽  
Palmar Cutaneous Branch ◽  
Cutaneous Branch ◽  
Distal Fixation ◽  
Extensor Carpi Radialis

The superficial sensory branch of the radial nerve appears prone to develop painful neuromas out of proportion to its likelihood for injury. Based on cadaver dissections and intraoperative observations, an anatomical mechanism for this “predisposition” is suggested. Exit of this nerve beneath dense fascia and the tendons of brachioradialis and extensor carpi radialis longus provide a proximal tethering against which tension develops as the distal fixation point (neuroma) is pulled through the long excursion of wrist are of motion. This long excursion and proximal tethering are not present anatomically for the dorsal cutaneous branch of the ulnar nerve nor the palmar cutaneous branch of the median nerve.

scholarly journals TRANSFER OF THE RADIAL NERVE BRANCHES FOR THE TREATMENT OF THE ANTERIOR INTEROSSEOUS NERVE LESION: AN ANATOMICAL STUDY

2019 ◽  
Vol 27 (6) ◽  
pp. 298-303
Author(s):  
Fernando César Matavelli Júnior ◽  
Lucas Gobbi ◽  
Marcos Paulo Sales dos Santos ◽  
Edie Benedito Caetano ◽  
Luiz Angelo Vieira ◽  
...  
Keyword(s):  
Median Nerve ◽  
Radial Nerve ◽  
Case Series ◽  
Anatomical Study ◽  
Flexor Digitorum Profundus ◽  
Common Trunk ◽  
Nerve Lesion ◽  
Level Of Evidence ◽  
Flexor Digitorum ◽  
Extensor Carpi Radialis

ABSTRACT Objective: This anatomical study aimed to analyze the possibility of transferring the radial nerve branches destined to the brachioradialis (BR), extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), and supinator (SM) muscles to innervate the AIN. Methods: Ten limbs from five male cadavers were prepared by intra-arterial injection of a solution of 10% glycerol and formalin. Results: The presence of only one branch to the BR muscle was noted in 7 limbs and two branches were noted in three limbs. In two members of a common trunk with branch to the ECRL. In eight cases, we identified one branch for the ERLC and two branches in two cases. We identified only one branch for the ECRB, while in six limbs, two branches were noted, penetrating the muscular body at two different points. We identified at least two branches innervating the supinator muscle. The AIN was detached from the median nerve distal to the intercondylar line of the humerus. In seven limbs, it originated from the nervous fascicles of the posterior region of the median nerve and from the posterolateral fascicles in three limbs. The flexor pollicis longus and flexor digitorum profundus muscles received more than one branch of the AIN in all limbs. Conclusion: The radial nerve branches for the ECRL, ECRB, and supinator muscles can be transferred directly to the AIN or to one of its branches after intraneural dissection, without tension even in elbow movements. Level of Evidence IV; Case series.

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