Transfer of the Medial Pectoral Nerve: Myth or Reality?

Neurosurgery ◽  
2002 ◽  
Vol 50 (6) ◽  
pp. 1277-1282 ◽  
Author(s):  
Miroslav Samardzic ◽  
Danica Grujicic ◽  
Lukas Rasulic ◽  
Dragoljub Bacetic
Keyword(s):  
Functional Recovery ◽  
Time Course ◽  
Nerve Transfer ◽  
Spinal Nerve ◽  
Axillary Nerve ◽  
Musculocutaneous Nerve ◽  
Strong Trend ◽  
Pectoral Nerve ◽  
Medial Pectoral Nerve ◽  
Significant Difference

Abstract OBJECTIVE Transfer of the medial pectoral nerve is one of the most controversial procedures used to reinnervate the paralyzed upper arm because of brachial plexus spinal nerve root avulsion or directly irreparable proximal lesions of spinal nerves. The purpose of this study was to determine the value of this type of nerve transfer to the musculocutaneous and axillary nerves. METHODS The 25 patients included in the study comprised 14 patients who had nerve transfer to the musculocutaneous nerve and 11 who underwent nerve transfer to the axillary nerve. These patients’ functional recovery and the time course of their recovery were analyzed according to the type of transfer of one donor nerve or the donor nerve in combination with other donors. RESULTS Useful functional recovery was achieved in 85.7% of patients who had nerve transfer to the musculocutaneous nerve and in 81.8% of patients who underwent nerve transfer to the axillary nerve. There was no significant difference in results with regard to the type of nerve transfer and which recipient nerves were involved. A strong trend toward better results after procedures involving the use of a donor nerve combined with other donors was observed, however. CONCLUSION Our surgical results suggest that the transfer of the medial pectoral nerve to the musculocutaneous nerve and also to the axillary nerve may be a reliable and effective procedure.

Medial pectoral nerve to musculocutaneous nerve neurotization for the treatment of persistent birth-related brachial plexus palsy: an 11-year institutional experience

2009 ◽  
Vol 3 (5) ◽  
pp. 348-353 ◽  
Author(s):  
John C. Wellons ◽  
R. Shane Tubbs ◽  
Jeffrey A. Pugh ◽  
Nadine J. Bradley ◽  
Charles R. Law ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Functional Recovery ◽  
Traumatic Injury ◽  
Elbow Flexion ◽  
Musculocutaneous Nerve ◽  
Brachial Plexus Palsy ◽  
Pectoral Nerve ◽  
Medial Pectoral Nerve ◽  
Institutional Experience

Object Medial pectoral nerve (MPN) to musculocutaneous nerve (MCN) neurotization for recovery of elbow flexion by biceps reinnervation is a valid option following traumatic injury to the upper brachial plexus. A major criticism of the application of this technique in infants is the smaller size of the MPN and mismatch of viable axons. We describe our institutional experience utilizing this procedure and critically examine functional outcomes. Methods Office charts and hospital records of children from over an 11-year period beginning January 1997 were reviewed. Of the 53 children of various ages undergoing brachial plexus exploration for traumatic injury of any nature, 20 underwent MPN to MCN neurotization as a part of an overall procedure in the first year of life to treat birth-related brachial plexus palsy and had at least 9 months' follow-up. Medial pectoral nerve to MCN neurotization was chosen if the results of clinical examination and intraoperative electrophysiological evidence were consistent with medial cord function. Functional recovery was defined as the ability of the child to bring their hand to their mouth. Results Sixteen patients (80%) gained functional recovery. The median age at surgery was 7 months. Median time to first clinic visit documenting recovery was 11.5 months and median overall follow up was 21.5 months. Preoperative hand function was a useful predictor of recovery of elbow flexion. Conclusions Medial pectoral nerve to MCN neurotization is a valid surgical option for the reinnervation of the biceps muscle for birth-related brachial plexus palsy when the hand is functional preoperatively. Useful elbow flexion can be expected in the majority of these children.

scholarly journals Medial Pectoral Nerve to Axillary Nerve Neurotization following Traumatic Brachial Plexus Injuries: Indications and Clinical Outcomes

Hand ◽  
2011 ◽  
Vol 7 (1) ◽  
pp. 59-65 ◽  
Author(s):  
Wilson Z. Ray ◽  
Rory K. J. Murphy ◽  
Katherine Santosa ◽  
Philip J. Johnson ◽  
Susan E. Mackinnon
Keyword(s):  
Brachial Plexus ◽  
Clinical Outcomes ◽  
Axillary Nerve ◽  
Pectoral Nerve ◽  
Medial Pectoral Nerve

Transfer of Pectoral Nerves to the Musculocutaneous Nerve in Obstetric Upper Brachial Plexus Palsy

Neurosurgery ◽  
2003 ◽  
Vol 53 (2) ◽  
pp. 338-342 ◽  
Author(s):  
Gerhard Blaauw ◽  
Albert C.J. Slooff
Keyword(s):  
Standard Deviation ◽  
Brachial Plexus ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Musculocutaneous Nerve ◽  
Nerve Endings ◽  
Nerve Plexus ◽  
Brachial Plexus Palsy ◽  
Pectoral Nerve

Abstract OBJECTIVE To investigate the results of transfer of pectoral nerves to the musculocutaneous nerve for treatment of obstetric brachial palsy. METHODS In 25 cases of obstetric brachial palsy (20 after breech deliveries), branches of the pectoral nerve plexus were transferred directly to the musculocutaneous nerve. For all patients, the nerve transfer was part of an extended brachial plexus reconstruction. Results were tested both clinically and with the Mallet scale, at a mean follow-up time of 70 months (standard deviation, 34.3 mo). RESULTS There were two complete failures, which were attributable to disconnection of the transferred nerve endings. The results after transfer were excellent in 17 cases and fair in 5 cases. Steindler flexorplasty improved elbow flexion for three patients. CONCLUSION Transfer of pectoral nerves to the musculocutaneous nerve for treatment of obstetric upper brachial palsy may be effective, if the specific anatomic features of the pectoral nerve plexus are sufficiently appreciated.

Restoration of Shoulder Abduction after Radial to Axillary Nerve Transfer following Trauma or Shoulder Arthroplasty

2013 ◽  
Vol 3 (1) ◽  
pp. 99-103
Author(s):  
James A Nunley ◽  
Fraser J Leversedge ◽  
Walter H Wray ◽  
J Mack Aldridge
Keyword(s):  
Nerve Injury ◽  
Shoulder Arthroplasty ◽  
Radial Nerve ◽  
Conflicts Of Interest ◽  
Case Series ◽  
Nerve Transfer ◽  
Axillary Nerve ◽  
Shoulder Abduction ◽  
Anterior Branch ◽  
Significant Difference

ABSTRACT Purpose A loss of active shoulder abduction due to axillary nerve dysfunction may be caused by brachial plexus or isolated axillary nerve injury and is often associated with a severe functional deficit. The purpose of this study was to evaluate retrospectively the restoration of deltoid strength and shoulder abduction after transfer of a branch of the radial nerve to the axillary nerve for patients who had sustained an axillary nerve injury. Materials and methods We retrospectively reviewed all patients who underwent transfer of a branch of the radial nerve to the anterior branch of the axillary nerve at our institution, either alone or in combination with other nerve transfers, between 2004 and 2011. We identified, by chart review, 12 patients with an average follow-up of 16.7 months (6-36 months) who met inclusion criteria. Results Active shoulder abduction significantly improved from an average of 9.6° (0-60°) to 84.5° (0-160°) (p < 0.005). Average initial deltoid strength significantly improved from 0.3 (0-2) on the M scale to an average postoperative deltoid strength of 2.8 (0-5) (p < 0.005). Five of 12 (41.7%) achieved at least M4 strength and eight of 12 (66.7%) achieved at least M3 strength. No statistically significant difference was seen when subgroup analysis was performed for isolated nerve transfer vs multiple nerve transfer, mechanism of injury with MVC vs shoulder arthroplasty, age, branch of radial nerve transferred, or time from injury to surgery. No significant change in triceps strength was observed with an average of 4.9 (4-5) strength preoperatively and 4.8 (4-5) postoperatively (p = 0.34). There were three patients who achieved no significant gain in shoulder abduction or deltoid strength for unknown reasons. Conclusion Transfer of a branch of the radial nerve to the anterior branch of the axillary nerve is successful in improving deltoid strength and shoulder abduction in most patients. Our series, the largest North American series to our knowledge, has not shown outcomes as favorable as other series. Larger multicenter trials are needed. Type of study/Level of evidence This is a retrospective case series representing a level IV study. Funding No outside funding was received and the authors have no conflicts of interest to disclose. Wray WH III, Aldridge JM III, Nunley JA II, Ruch DS, Leversedge FJ. Restoration of Shoulder Abduction after Radial to Axillary Nerve Transfer following Trauma or Shoulder Arthroplasty. The Duke Orthop J 2013;3(1):99-103.

scholarly journals Collateral branches of the brachial plexus as donors in nerve transfers

2012 ◽  
Vol 69 (7) ◽  
pp. 594-603 ◽  
Author(s):  
Miroslav Samardzic ◽  
Lukas Rasulic ◽  
Novak Lakicevic ◽  
Vladimir Bascarevic ◽  
Irena Cvrkota ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Statistical Significance ◽  
Axillary Nerve ◽  
Shoulder Abduction ◽  
Quality Of Recovery ◽  
Nerve Transfers ◽  
Pectoral Nerve ◽  
Medial Pectoral Nerve ◽  
Thoracodorsal Nerve

Background/Aim. Nerve transfers in cases of directly irreparable, or high level extensive brachial plexus traction injuries are performed using a variety of donor nerves with various success but an ideal method has not been established. The purpose of this study was to analyze the results of nerve transfers in patients with traction injuries to the brachial plexus using the thoracodorsal and medial pectoral nerves as donors. Methods. This study included 40 patients with 25 procedures using the thoracodorsal nerve and 33 procedures using the medial pectoral nerve as donors for reinnervation of the musculocutaneous or axillary nerve. The results were analyzed according to the donor nerve, the age of the patient and the timing of surgery. Results. The total rate of recovery for elbow flexion was 94.1%, for shoulder abduction 89.3%, and for shoulder external rotation 64.3%. The corresponding rates of recovery using the thoracodorsal nerve were 100%, 93.7% and 68.7%, respectively. The rates of recovery with medial pectoral nerve transfers were 90.5%, 83.3% and 58.3%, respectively. Despite the obvious differences in the rates of recovery, statistical significance was found only between the rates and quality of recovery for the musculocutaneous and axillary nerve using the thoracodorsal nerve as donor. Conclusion. According to our findings, nerve transfers using collateral branches of the brachial plexus in cases with upper palsy offer several advantages and yield high rate and good quality of recovery.

Intercostal and pectoral nerve transfers to re-innervate the biceps muscle in obstetric brachial plexus lesions

2013 ◽  
Vol 39 (6) ◽  
pp. 647-652 ◽  
Author(s):  
W. Pondaag ◽  
M. J. A. Malessy
Keyword(s):  
Brachial Plexus ◽  
Nerve Transfer ◽  
Intercostal Nerve ◽  
Consecutive Series ◽  
Biceps Muscle ◽  
Nerve Transfers ◽  
Pectoral Nerve ◽  
Medial Pectoral Nerve ◽  
Obstetric Brachial Plexus ◽  
Transfer Group

In obstetric brachial plexus lesions with avulsion injury, nerve grafting for biceps muscle re-innervation may not be possible owing to the unavailability of a proximal stump. In such cases, the intercostal nerves or medial pectoral nerve can serve as donor nerves in an end-to-end transfer to the musculocutaneous nerve. The present study reports the results of both techniques from a single institution in a consecutive series of 42 patients between 1995 and 2008. From 1995 to 2000 we always used the intercostal nerve transfer, and from 2001 to 2008 both techniques were used. Biceps muscle force ≥Medical Research Council Grade 3 was achieved in 37 of 42 patients after a mean follow-up of 44 months. There was no statistical difference in the results in the medial pectoral nerve transfer group ( n = 25) and the intercostal nerve transfer group ( n = 17).

Surgical Relationship of the Medial Pectoral Nerve to the Musculocutaneous Nerve: A Cadaveric Study

Neurosurgery ◽  
2001 ◽  
Vol 48 (1) ◽  
pp. 203-207 ◽  
Author(s):  
Ake Hansasuta ◽  
R. Shane Tubbs ◽  
Paul A. Grabb
Keyword(s):  
Cross Sectional Area ◽  
Musculocutaneous Nerve ◽  
Sectional Area ◽  
Cross Sectional ◽  
Lateral Cord ◽  
Pectoral Nerve ◽  
Medial Pectoral Nerve ◽  
Pectoralis Muscles ◽  
Average Factor ◽  
The Cross

Abstract OBJECTIVE For purposes of neurotization of the musculocutaneous nerve (MCN) with the medial pectoral nerve (MPN) after upper trunk brachial plexus injuries, the anatomic relationship between these two nerves was defined in a cadaveric model. METHODS Thirty-five brachial plexuses in 18 adult cadavers were dissected. The distance between the origin of the MPN from the medial cord to the origin of the MCN from the lateral cord was measured. The length, diameter, branching, and location of the MPN were recorded. The diameter of the proximal MCN was recorded. RESULTS Thirty-seven percent of the MPNs, when detached from the pectoralis muscles, were too short to reach the proximal MCN by a mean distance of 15 mm. The MPN pierced the pectoralis minor muscle in 80% of the dissections. The cross sectional area of the MCN was always larger than the cross sectional area of the MPN by an average factor of 2.5. CONCLUSION When planning to use the MPN for neurotization of the MCN, one should be prepared to harvest an interposition graft, because over one-third of MPNs may not have enough length to reach the MCN in a tension-free manner. Diameter mismatch occurs predictably between the distal MPN and the proximal MCN.

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