Supinator to Posterior Interosseous Nerve Transfer for Restoration of Finger Extension

2021 ◽  
Author(s):  
Stanley Bazarek ◽  
Margaret Sten ◽  
Darren Nin ◽  
Justin M Brown
Keyword(s):  
Spinal Cord ◽  
Brachial Plexus ◽  
Spinal Cord Injuries ◽  
Brachial Plexus Injury ◽  
Cervical Spinal Cord ◽  
Nerve Transfer ◽  
Posterior Interosseous Nerve ◽  
Loss Of Function ◽  
Finger Extension ◽  
Supinator Muscle

Abstract BACKGROUND Cervical spinal cord injuries result in a severe loss of function and independence. The primary goal for these patients is the restoration of hand function. Nerve transfers have recently become a powerful intervention to restore the ability to grasp and release objects. The supinator muscle, although a suboptimal tendon transfer donor, serves as an ideal distal nerve donor for reconstructive strategies of the hand. This transfer is also applicable to lower brachial plexus injuries. OBJECTIVE To describe the supinator to posterior interosseous nerve transfer with the goal of restoring finger extension following spinal cord or lower brachial plexus injury. METHODS Nerve branches to the supinator muscle are transferred to the posterior interosseous nerve supplying the finger extensor muscles in the forearm. RESULTS The supinator to posterior interosseous nerve transfer is effective in restoring finger extension following spinal cord or lower brachial plexus injury. CONCLUSION This procedure represents an optimal nerve transfer as the donor nerve is adjacent to the target nerve and its associated muscles. The supinator muscle is innervated by the C5-6 nerve roots and is often available in cases of cervical SCI and injuries of the lower brachial plexus. Additionally, supination function is retained by supination action of the biceps muscle.

The influence of GDNF on the timecourse and extent of motoneuron loss in the cervical spinal cord after brachial plexus injury in the neonate

2004 ◽  
Vol 26 (2) ◽  
pp. 211-217 ◽  
Author(s):  
Oskar C. Aszmann ◽  
Tobias Winkler ◽  
Klaus Korak ◽  
Hans Lassmann ◽  
Manfred Frey
Keyword(s):  
Spinal Cord ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Cervical Spinal Cord

Combined proximal nerve graft and distal nerve transfer for a posterior cord brachial plexus injury

2013 ◽  
Vol 118 (1) ◽  
pp. 155-159 ◽  
Author(s):  
Johannes F. Plate ◽  
L. Kirsten Ely ◽  
Benjamin R. Pulley ◽  
Beth P. Smith ◽  
Zhongyu Li
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
High Energy ◽  
Nerve Graft ◽  
Posterior Interosseous Nerve ◽  
Management Guidelines ◽  
Distal Nerve

The treatment of patients with prolonged denervation from a posterior cord brachial plexus injury is challenging and no management guidelines exist to follow. The authors describe the case of a 26-year-old man who presented to our clinic for treatment 11 months after suffering a high-energy injury to the posterior cord of the brachial plexus. A combined 9-cm proximal cable nerve graft procedure and a pronator branch to the posterior interosseous nerve transfer were performed. Satisfactory deltoid, triceps, wrist, and finger extensor recovery was noted 3 years after surgery. Patients with prolonged denervation from posterior cord injuries can be successfully treated with a combination of a proximal nerve graft and a distal nerve transfer.

Transfer of supinator motor branches to the posterior interosseous nerve in C7–T1 brachial plexus palsy

2010 ◽  
Vol 113 (1) ◽  
pp. 129-132 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Marcos Flavio Ghizoni
Keyword(s):  
Brachial Plexus ◽  
Index Finger ◽  
Motor Nerve ◽  
Anatomical Study ◽  
Nerve Transfer ◽  
Posterior Interosseous Nerve ◽  
Lateral Aspect ◽  
Finger Extension ◽  
Finger Flexion ◽  
Finger Motion

Object In C7–T1 palsies of the brachial plexus, shoulder and elbow function are preserved, but finger motion is absent. Finger flexion has been reconstructed by tendon or nerve transfers. Finger extension has been restored ineffectively by attaching the extensor tendons to the distal aspect of the dorsal radius (termed tenodesis) or by tendon transfers. In these palsies, supinator muscle function is preserved, because innervation stems from the C-6 root. The feasibility of transferring supinator branches to the posterior interosseous nerve has been documented in a previous anatomical study. In this paper, the authors report the clinical results of supinator motor nerve transfer to the posterior interosseous nerve in 4 patients with a C7–T1 root lesion. Methods Four adult patients with C7–T1 root lesions underwent surgery between 5 and 7 months postinjury. The patients had preserved motion of the shoulder, elbow, and wrist, but they had complete palsy of finger motion. They underwent finger flexion reconstruction via transfer of the brachialis muscle, and finger and thumb extension were restored by transferring the supinator motor branches to the posterior interosseous nerve. This nerve transfer was performed through an incision over the proximal third of the radius. Dissection was carried out between the extensor carpi radialis brevis and the extensor digitorum communis. The patients were followed up as per regular protocol and underwent a final evaluation 12 months after surgery. To document the extent of recovery, the authors assessed the degree of active metacarpophalangeal joint extension of the long fingers. The thumb span was evaluated by measuring the distance between the thumb pulp and the lateral aspect of the index finger. Results Surgery to transfer the supinator motor branches to the posterior interosseous nerve was straightforward. Twelve months after surgery, all patients were capable of opening their hand and could fully extend their metacarpophalangeal joints. The distance of thumb abduction improved from 0 to 5 cm from the lateral aspect of the index finger. Conclusions Transferring supinator motor nerves directly to the posterior interosseous nerve is effective in at least partially restoring thumb and finger extension in patients with lower-type injuries of the brachial plexus.

Clinical use of supinator motor branch transfer to the posterior interosseous nerve in C7–T1 brachial plexus palsies

2010 ◽  
Vol 113 (1) ◽  
pp. 113-117 ◽  
Author(s):  
Zhen Dong ◽  
Yu-Dong Gu ◽  
Cheng-Gang Zhang ◽  
Lei Zhang
Keyword(s):  
Brachial Plexus ◽  
Reliable Method ◽  
Nerve Transfer ◽  
Posterior Interosseous Nerve ◽  
Viable Option ◽  
Motor Branch ◽  
Finger Extension ◽  
Finger Flexion ◽  
Anterior Interosseous Nerve

Object In C7–T1 brachial plexus palsies, finger extension and flexion are absent. At the authors' institution, finger flexion has been successfully reconstructed by transferring the brachialis motor branch to the anterior interosseous nerve. However, there is no reliable method for restoring finger extension. In the present study, the authors examined the surgical results of transferring the supinator motor branch to the posterior interosseous nerve. Methods Since October 2007, the authors have performed a supinator motor branch transfer to the posterior interosseous nerve in 4 patients. The patients underwent follow-up every 3–4 months postoperatively. Results Finger extension appeared between 5 and 9 months in the first 3 cases and demonstrated promising improvement over time. One recent case remains under follow-up. Conclusions A supinator motor branch to posterior interosseous nerve transfer leads to reliable recovery of thumb and finger extension. Therefore, it is a viable option for C7–T1 brachial plexus palsies.

Anatomical feasibility of transferring supinator motor branches to the posterior interosseous nerve in C7–T1 brachial plexus palsies

2009 ◽  
Vol 111 (2) ◽  
pp. 326-331 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Paulo Roberto Kechele ◽  
Marcos Antonio Santos ◽  
Bruno Adler Maccagnan Pinheiro Besen ◽  
Hamilton Duarte
Keyword(s):  
Brachial Plexus ◽  
Muscle Function ◽  
Histological Study ◽  
Posterior Interosseous Nerve ◽  
Nerve Transfers ◽  
Finger Extension ◽  
Distal Side ◽  
Finger Flexion ◽  
Supinator Muscle ◽  
Motor Nerves

Object In C7–T1 palsies of the brachial plexus, shoulder and elbow function is preserved, but finger motion is absent. Finger flexion has been reconstructed using tendon or nerve transfers. Finger extension has been restored ineffectively by attaching the extensor tendons to the distal side of the dorsal radius (that is, tenodesis). In these types of nerve palsy, supinator muscle function is preserved because innervation stems from the C-6 root. In the present study, the authors investigated the anatomy and the feasibility of transferring the supinator motor branches to the posterior interosseous nerve. Sacrifice of the supinator motor branches does not abolish supination because biceps muscle function is preserved in lower-type injuries of the brachial plexus. Methods The posterior interosseous nerve was dissected in 20 formalin-fixed forearms. Through posterior forearm access, the posterior interosseous nerve and its motor branches to the supinator muscle were dissected. Specimens were removed for histological study. Results In the vicinity of the supinator muscle's proximal margin (that is, the Frohse arcade), 2 nerve branches arose laterally and medially from the posterior interosseous nerve to innervate the superficial and deep heads of the supinator muscle, respectively. The supinator motor nerves, when divided, could be coapted directly to the posterior interosseous nerve. The number of myelinated fibers in the supinator motor branches corresponded to 70% that of the posterior interosseous nerve. Conclusions The supinator motor nerves can be transferred directly to the posterior interosseous nerve to restore thumb and finger extension in patients with C7–T1 brachial plexus lesions.

A novel strategy for repairing preganglionic cervical root avulsion in brachial plexus injury by sural nerve grafting

2009 ◽  
Vol 110 (4) ◽  
pp. 775-785 ◽  
Author(s):  
Jau-Ching Wu ◽  
Wen-Cheng Huang ◽  
Ming-Chao Huang ◽  
Yun-An Tsai ◽  
Yu-Chun Chen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Muscle Strength ◽  
Medical Research ◽  
Brachial Plexus ◽  
Sural Nerve ◽  
Research Council ◽  
Medical Research Council ◽  
Brachial Plexus Injury ◽  
Cervical Spinal Cord ◽  
Nerve Grafting

Object In this study, the authors evaluated the efficacy of a new surgical strategy for reconnecting the injured brachial plexus with the spinal cord using fibrin glue containing acidic fibroblast growth factor as an adhesive and neurotrophic agent. Methods Eighteen patients with preganglionic brachial plexus injuries, each with varying degrees of upper limb dysfunction, underwent cervical laminectomy with or without sural nerve grafting. The treatment of each avulsed root varied according to the severity of the injury. Some patients also underwent a second-stage operation involving supraclavicular brachial plexus exploration for reconnection with the corresponding segment of cervical spinal cord at the trunk level. Muscle strength was graded both pre- and postoperatively with the British Medical Research Council scale, and the results were analyzed with the Friedman and Wilcoxon signed-rank tests. Results Muscle strength improvements were observed in 16 of the 18 patients after 24 months of follow-up. Significant improvements in mean muscle strength were observed in patients from all repair method groups at 12 and 24 months postoperatively (p < 0.05). Statistical significance was not reached in the groups with insufficient numbers of cases. Conclusions The authors' new surgical strategy yielded clinical improvement in muscle strength after preganglionic brachial plexus injury, such that nerve regeneration may have taken place. Reconnection of the brachial plexus to the cervical spinal cord is possible. Functional motor recovery, observed through increases in Medical Research Council–rated muscle strength in the affected arm, is likewise possible.

Impairment Rating and Spinal Cord Injuries: Revisiting the Guides

2010 ◽  
Vol 15 (3) ◽  
pp. 1-7
Author(s):  
Richard T. Katz
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Functional Independence ◽  
Outcome Data ◽  
Multiple Organ ◽  
Loss Of Function ◽  
Sixth Edition ◽  
Organ Systems ◽  
Cord Injury ◽  
Impairment Ratings

Abstract This article addresses some criticisms of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) by comparing previously published outcome data from a group of complete spinal cord injury (SCI) persons with impairment ratings for a corresponding level of injury calculated using the AMA Guides, Sixth Edition. Results of the comparison show that impairment ratings using the sixth edition scale poorly with the level of impairments of activities of daily living (ADL) in SCI patients as assessed by the Functional Independence Measure (FIM) motor scale and the extended FIM motor scale. Because of the combinations of multiple impairments, the AMA Guides potentially overrates the impairment of paraplegics compared with that of quadriplegics. The use and applicability of the Combined Values formula should be further investigated, and complete loss of function of two upper extremities seems consistent with levels of quadriplegia using the SCI model. Some aspects of the AMA Guides contain inconsistencies. The concept of diminishing impairment values is not easily translated between specific losses of function per organ system and “overall” loss of ADLs involving multiple organ systems, and the notion of “catastrophic thresholds” involving multiple organ systems may support the understanding that variations in rating may exist in higher rating cases such as those that involve an SCI.

How to Do It: Microsurgical DREZotomy for Pain After Brachial Plexus Injury: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Manon Duraffourg ◽  
Andrei Brinzeu ◽  
Marc Sindou
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Brachial Plexus ◽  
Dorsal Horn ◽  
Brachial Plexus Injury ◽  
Dorsal Column ◽  
Motor Deficit ◽  
Complete Disappearance ◽  
Burning Pain ◽  
Root Entry Zone

Abstract More than three-quarters of victims of brachial plexus injury suffer from refractory neuropathic pain.1-6 Main putative mechanism is paroxysmal hyperactivity in the dorsal horn neurons at the dorsal root entry zone (DREZ) as demonstrated by microelectrode recordings in animal models7 and patients.8 Pain relief can be achieved by lesioning the responsible neurons in the spinal cord segments with avulsed rootlets.9,10  This video illustrates the technique for microsurgical DREZotomy.11,12 A C3-C7 hemilaminectomy is performed to access the C4-Th1 medullary segments. After opening the dura and arachnoid, and freeing the cord from arachnoid adhesions, the dorsolateral sulcus is identified. Identification can be difficult when the spinal cord is distorted and/or has a loss of substance. The dorsolateral sulcus is then opened with a microknife, so that microcoagulations are performed: 4 mm deep, at 35° angle in the axis of the dorsal horn, every millimeter in a dotted fashion along the avulsed segments. Care should be taken not to damage the corticospinal tract, laterally, and the dorsal column, medially.  The patient consents to the procedure. In the presented case, surgery led to complete disappearance of the paroxysmal pain and reduced the background of burning pain to a bearable level without the need of opioid medication. There was no motor deficit or ataxia in the ipsilateral lower limb postoperatively. According to Kaplan-Meier analysis at 10 yr follow-up, in our overall series, microsurgical DREZotomy achieved total pain relief without any medication in 60% of patients, and in 85% without the need for opioids.10,13-15  Microelectrode recording at 1:26 reproduced from Guenot et al7 with permission from JNSPG.

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