Transfer of the Pronator Quadratus Motor Branch for Wrist Extension Reconstruction in Brachial Plexus Palsy

2012 ◽  
Vol 130 (6) ◽  
pp. 1269-1278 ◽  
Author(s):  
Jayme A. Bertelli ◽  
Cristiano P. Tacca ◽  
Elisa C. Winkelmann Duarte ◽  
Marcos F. Ghizoni ◽  
Hamilton Duarte
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Palsy ◽  
Wrist Extension ◽  
Pronator Quadratus ◽  
Motor Branch

scholarly journals Results of wrist extension reconstruction in C5–8 brachial plexus palsy by transferring the pronator quadratus motor branch to the extensor carpi radialis brevis muscle

2016 ◽  
Vol 124 (5) ◽  
pp. 1442-1449 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Marcos Flávio Ghizoni ◽  
Cristiano Paulo Tacca
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Palsy ◽  
Wrist Extension ◽  
Pronator Quadratus ◽  
Motor Branch ◽  
Extensor Carpi Radialis

OBJECT The objective of this study was to report the results of pronator quadratus (PQ) motor branch transfers to the extensor carpi radialis brevis (ECRB) motor branch to reconstruct wrist extension in C5–8 root lesions of the brachial plexus. METHODS Twenty-eight patients, averaging 24 years of age, with C5–8 root injuries underwent operations an average of 7 months after their accident. In 19 patients, wrist extension was impossible at baseline, whereas in 9 patients wrist extension was managed by activating thumb and wrist extensors. When these 9 patients grasped an object, their wrist dropped and grasp strength was lost. Wrist extension was reconstructed by transferring the PQ motor to the ECRB motor branch. After surgery, patients were followed for at least 12 months, with final follow-up an average of 22 months after surgery. RESULTS Successful reinnervation of the ECRB was demonstrated in 27 of the 28 patients. In 25 of the patients, wrist extension scored M4, and in 2 it scored M3. CONCLUSIONS In C5–8 root injuries, wrist extension can be predictably reconstructed by transferring the PQ motor branch to reinnervate the ECRB.

scholarly journals Pronator Quadratus to Extensor Carpi Radialis Brevis Nerve Transfer in C5–C7 or C5–C8 Brachial Plexus Injuries for Independent Wrist Extension

2020 ◽  
Vol 53 (01) ◽  
pp. 036-041
Author(s):  
Anil Bhatia ◽  
Mahmoud Salama
Keyword(s):  
Brachial Plexus ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Wrist Extension ◽  
Pronator Quadratus ◽  
Motor Branch ◽  
Nerve Surgery ◽  
Extensor Carpi Radialis

Abstract Background Patients with lesions affecting C7 and C8 roots (in addition to C56) demonstrate loss of independent wrist dorsiflexion in addition to loss of shoulder abduction and elbow flexion. Traditionally, this deficit has been addressed using tendon transfers after useful function at the shoulder and elbow has been restored by primary nerve surgery. Confidence with nerve transfer techniques has prompted attempts to replace this method by incorporating procedures for wrist dorsiflexion in the primary operation itself. Aim The objective of this study was to report the results of pronator quadratus motor branch transfers to the extensor carpi radialis brevis motor branch to reconstruct wrist extension in C5–C8 root lesions of the brachial plexus. Patients and Methods Twenty-three patients, average age 30 years, with C5–8 root injuries underwent operations an average of 4.7 months after their accident. Extrinsic extension of the fingers and thumb was weak or absent in two cases while the remaining 18 patients could open their hand actively. The patients lacked independent wrist extension when they were examined with the fingers flexed as the compensatory action of the extrinsic finger extensors was removed. The average follow-up was 21 months postoperative with the minimal follow-up period was at least 12 months. Results Successful reinnervations of the extensor carpi radialis brevis (ECRB) were demonstrated in all patients. In 17 patients, wrist extension scored M4, and in 3 patients it scored M3. Conclusions The pronator quadratus (PQ) to ECRB nerve transfer in C5–C7 or C5–C8 brachial plexus injuries for independent wrist extension reconstruction gives consistently good results with minimal donor morbidity.

Tendon Transfer to Reconstruct Wrist Extension in Children with Obstetric Brachial Plexus palsy

2003 ◽  
Vol 28 (2) ◽  
pp. 153-157 ◽  
Author(s):  
M. M. Al-QATTAN
Keyword(s):  
Brachial Plexus ◽  
Tendon Transfer ◽  
Brachial Plexus Palsy ◽  
Wrist Extension ◽  
Obstetric Brachial Plexus Palsy ◽  
System A ◽  
Flexor Carpi Ulnaris ◽  
Obstetric Brachial Plexus ◽  
Wrist Drop ◽  
Extensor Carpi Radialis

This study reports on 20 children with obstetric brachial plexus palsy who underwent a tendon transfer to reconstruct wrist extension. The mean age at the time of tendon transfer was 8 years. There were seven patients with Erb’s palsy and the remaining 13 had total palsy. The flexor carpi ulnaris was utilized 15 times and the flexor carpi radialis five times. The transferred tendon was sutured to the tendon of the extensor carpi radialis brevis. The result of the transfer was assessed according to a modified Medical Research Council (MRC) muscle grading system. A good result was obtained in 18 patients (modified MRC grade of 4) and a fair result (modified MRC grade of 3) in two. The choice of tendon transfer to reconstruct the wrist drop deformity in various conditions including adult traumatic brachial plexus injuries is discussed.

Brachialis Muscle Transfer to the Forearm Muscles in Obstetric Brachial Plexus Palsy

2006 ◽  
Vol 31 (3) ◽  
pp. 261-265 ◽  
Author(s):  
J. A. BERTELLI
Keyword(s):  
Brachial Plexus ◽  
Hand Function ◽  
Brachial Plexus Palsy ◽  
Muscle Transfer ◽  
Wrist Extension ◽  
Active Motion ◽  
Obstetric Brachial Plexus Palsy ◽  
Brachialis Muscle ◽  
Obstetric Brachial Plexus ◽  
Extensor Carpi Radialis

Tendon transfers are frequently needed to improve hand function in obstetric brachial plexus injuries. The reconstruction cannot always be achieved using local donor transfers in the forearm as these are not always available. In such cases, we propose the use of the brachialis muscle as a useful donor for transfer. Five adolescents with obstetric brachial plexus palsy were operated on to reconstruct wrist extension and/or pronation using the brachialis muscle transfer to the pronator teres ( n = 1) extensor carpi radialis brevis ( n = 1) and extensor carpi radialis longus ( n = 3). Twelve months after surgery, average active motion recovery was 20° for wrist extension and 14° for pronation. Active and passive range of motion was similar.

scholarly journals Nerves transfers for functional hand recovery in traumatic lower brachial plexopathy

2020 ◽  
Vol 11 ◽  
pp. 358
Author(s):  
Fernando Henrique Souza ◽  
Silvya Nery Bernardino ◽  
Auricelio Batista Cezar Junior ◽  
Hugo André de Lima Martins ◽  
Isabel Nery Bernardino Souza ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Hand Function ◽  
Case Series ◽  
Significant Loss ◽  
Plexus Brachialis ◽  
Brachial Plexopathy ◽  
Pronator Quadratus ◽  
Motor Branch ◽  
Nerve Transfers

Background: Distal nerve transfers are an innovative modality for the treatment of C8-T1 brachial plexus lesions. The purpose of this case series is to report the authors’ results with hand restoration function by nerve transfer in patients with lower brachial plexus injury. Methods: Three consecutive nerve transfers were performed in a series of 11 patients to restore hand function after injury to the lower brachial plexus: brachialis motor branch to anterior interosseous nerve (AIN) and supinator branch to the posterior interosseous nerve (PIN) in a first surgical procedure, and AIN to pronator quadratus branch of ulnar nerve between 4 and 6 months later. Results: In all, 11 male patients underwent 33 surgical procedures. Time between brachial plexus injury and surgery was a mean of 11 months (range 4–13 months). Postoperative follow-up ranged from 12 to 24 months. We observed recovery of M3 or better finger flexion strength (AIN) and wrist extension (PIN) in 8 of the 11 surgically treated upper limbs. These patients recovered full thumb and finger extension between 6 and 12 months of surgery, without significant loss of donor function. Conclusion: Nerve transfers represent a way of restoring volitional control of upper extremity function in patients with C8-T1 brachial plexus injury.

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