Nerves transfers for functional hand recovery in traumatic lower brachial plexopathy

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.

Download Full-text

Double-Nerve Transfer to the Axillary Nerve in Traumatic Upper Trunk Brachial Plexus Injuries Using an Axillary Approach: Anatomical Description and Preliminary Case Series

Operative Neurosurgery ◽

10.1093/ons/opz430 ◽

2020 ◽

Vol 19 (2) ◽

pp. E131-E139 ◽

Cited By ~ 1

Author(s):

Thibault Lafosse ◽

Thibault Gerosa ◽

Julien Serane ◽

Michael Bouyer ◽

Emmanuel H Masmejean ◽

...

Keyword(s):

Brachial Plexus ◽

External Rotation ◽

Case Series ◽

Nerve Transfer ◽

Axillary Nerve ◽

Motor Deficit ◽

Motor Branch ◽

Axillary Approach ◽

Nerve Transfers ◽

Teres Minor

Abstract BACKGROUND Restoration of shoulder external rotation remains challenging in patients with C5/C6 brachial plexus injuries (BPI). OBJECTIVE To describe a double-nerve transfer to the axillary nerve (AN), targeting both its anterior and posterior motor branches, through an axillary route. METHODS A total of 10 fresh-frozen cadaveric brachial plexuses were dissected. Using an axillary approach, the infraclavicular brachial plexus terminal branches were exposed, including the axillary, ulnar, and radial nerves. Under microscopic magnification, the triceps long head motor branch (TLHMB), anteromedial fascicles of the ulnar nerve (UF), the anterior motor branch of the axillary nerve (AAMB), and the teres minor motor branch (TMMB) were dissected and transected to simulate 2 nerve transfers, THLMB-AAMB and UF-TMMB. Several anatomical criteria were assessed, including the overlaps between fascicles when placed side-by-side. Six patients with C5/C6 BPI were then operated on using this technique. RESULTS TLHMB-AAMB and UF-TMMB transfers could be simulated in all specimens, with mean overlaps of 37.1 mm and 6.5 mm, respectively. After a mean follow-up of 23 mo, all patients had recovered grade-3 strength or more in the deltoid and teres minor muscles. Mean active shoulder flexion, abduction, and external rotation with the arm 90° abducted were of 128°, 117°, and 51°, respectively. No postoperative motor deficit was found in the UF territory. CONCLUSION A double-nerve transfer, based on radial and ulnar fascicles, appears to be an adequate option to reanimate both motor branches of the AN, providing satisfactory shoulder active elevations and external rotation in C5/C6 BPI patients.

Download Full-text

Bionic reconstruction to restore hand function after brachial plexus injury: a case series of three patients

The Lancet ◽

10.1016/s0140-6736(14)61776-1 ◽

2015 ◽

Vol 385 (9983) ◽

pp. 2183-2189 ◽

Cited By ~ 60

Author(s):

Oskar C Aszmann ◽

Aidan D Roche ◽

Stefan Salminger ◽

Tatjana Paternostro-Sluga ◽

Malvina Herceg ◽

...

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Injury ◽

Hand Function ◽

Case Series ◽

Bionic Reconstruction

Download Full-text

Outcome of double nerve transfer close to target muscle both for shoulder abduction and elbow flexion in early C5 –C6 Brachial Plexus injury.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.07.4269 ◽

2020 ◽

Vol 27 (07) ◽

pp. 1442-1447

Author(s):

Husnain Khan ◽

Muhammad Shafique ◽

Zahid Iqbal Bhatti ◽

Tehseen Ahmad Cheema

Keyword(s):

Brachial Plexus ◽

Posterior Approach ◽

Brachial Plexus Injury ◽

Nerve Transfer ◽

Elbow Flexion ◽

Suprascapular Nerve ◽

Axillary Nerve ◽

Shoulder Abduction ◽

Motor Branch ◽

Nerve Transfers

Adult brachial plexus injury is a now a common problem due to high incidence of motorbike accidents. Among all types, C 5 and C6 (upper brachial plexus injury) is the most common. If the patient present within 6 months then nerve transfer is the preferred treatment. However, there are different options for nerve transfer and different approaches for surgery. Objectives: The objective of the study was to share our experience of nerve transfer close to target muscles in upper brachial plexus injury. Study Design: Quaisi experimental study. Setting: National Orthopaedic Hospital, Bahawalpur. Period: January 2015 to June 2018. Material & Methods: Total 32 patients were operated with isolated C5 and C6 injury. In all patients four nerve transfers were done. For shoulder abduction posterior approach was used and accessory to suprascapular nerve and one of motor branch of radial to axillary nerve were transferred. Modified Oberlin transfer was done for elbow flexion. Both shoulder abduction and elbow flexion was graded according to medical research council grading system. Results: After one year follow up more than 75% of the patients showed good to normal shoulder abduction and 87.50% showed good to normal elbow flexion. Residual Median nerve damage was noted only in two patients (6.25%). Conclusion: If there is no evidence of recovery up to three months early nerve transfer should be considered, ideal time is 3-6 months. Nerve transfer close to target muscle yields superior results. The shoulder stabilizers and abductors should ideally be innervated by double nerve transfer through posterior approach. Similarly double fascicular transfer (modified Oberlin) should be done for elbow flexion.

Download Full-text

Nerve Transfers for an Upper Brachial Plexus Injury: A Case Report

Indonesian Journal of Physical Medicine & Rehabilitation ◽

10.36803/ijpmr.v3i01.237 ◽

2014 ◽

Vol 3 (01) ◽

pp. 15-24

Author(s):

Ferry Senjaya

Keyword(s):

Brachial Plexus ◽

Functional Recovery ◽

Brachial Plexus Injury ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

External Rotation ◽

Nerve Transfer ◽

Elbow Flexion ◽

Motor Branch ◽

Nerve Transfers

Objective: To demonstrate multiple nerve transfers as primary surgical management for an upperplexus injury.Methods: A 6-year-old boy who suffered a preganglionic upper brachial plexus injury following a motor vehicle accident, exhibited complete biceps, deltoids, suprapinatus, and infraspinatus palsies.Multiple nerve transfers, which consist of spinal accessory nerves to suprascapular nerve transfer, median and ulnar motor fascicles to biceps and brachialis motor branches transfers, and long head oftriceps motor branch to axillary nerve transfer were performed 6 months after injury.Results: 13 months post multiple nerve transfer, the patient has regained M4+/5 elbow flexion, M4/5 external rotation, and M4/5 shoulder abduction.Conclusion: Nerve transfer is a viable option for upper plexus palsy management. With a sound surgical technique and good case selection, the results can be very rewarding. This case showedquite robust re-innervation with significant functional recovery at a one-year follow-up following multiple nerve transfers.Keywords: Brachial Plexus Injury, Upper Plexus Injury, Nerve Root Avulsion, Nerve Transfers, Functional Recovery.

Download Full-text

Multiple nerve and tendon transfers: a new strategy for restoring hand function in a patient with C7–T1 brachial plexus avulsions

Journal of Neurosurgery ◽

10.3171/2016.8.jns151749 ◽

2017 ◽

Vol 127 (4) ◽

pp. 837-842 ◽

Cited By ~ 2

Author(s):

Bin Xu ◽

Zhen Dong ◽

Cheng-Gang Zhang ◽

Yu-Dong Gu

Keyword(s):

Brachial Plexus ◽

Grip Strength ◽

Hand Function ◽

Motor Branch ◽

Pronator Teres ◽

Nerve Transfers ◽

Finger Flexion ◽

New Strategy ◽

Flexor Digitorum ◽

Flexion Strength

C7–T1 brachial plexus palsies result in a loss of finger motion and hand function. The authors have observed that finger flexion motion can be recovered after a brachialis motor branch transfer. However, finger flexion strength after this procedure merely corresponds to Medical Research Council Grades M2–M3, lowering the grip strength and practical value of the reconstructed hand. Therefore, they used 2 donor nerves and accomplished double nerve transfers for stronger finger flexion. In a patient with a C7–T1 brachial plexus injury, they transferred the pronator teres branch to the anterior interosseous nerve and the brachialis motor branch to the flexor digitorum superficialis branch for reinnervation of full finger flexors. Additionally, the supinator motor branch was transferred for finger extension, and the brachioradialis muscle was used for thumb opposition recovery. Through this new strategy, the patient could successfully accomplish grasping and pinching motions. Moreover, compared with previous cases, the patient in the present case achieved stronger finger flexion and grip strength, suggesting practical improvements to the reconstructed hand.

Download Full-text

RESTORATION OF HAND FUNCTION AFTER BRACHIAL PLEXUS INJURY

Hand Clinics ◽

10.1016/s0749-0712(21)00273-0 ◽

1995 ◽

Vol 11 (4) ◽

pp. 647-656

Author(s):

Chantal Bonnard ◽

Algimantas Narakas

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Injury ◽

Hand Function

Download Full-text

Comparing the Efficacy of Triple Nerve Transfers with Nerve Graft Reconstruction in Upper Trunk Obstetric Brachial Plexus Injury

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000003668 ◽

2017 ◽

Vol 140 (4) ◽

pp. 747-756 ◽

Cited By ~ 10

Author(s):

Kathleen M. O’Grady ◽

Hollie A. Power ◽

Jaret L. Olson ◽

Michael J. Morhart ◽

A. Robertson Harrop ◽

...

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Injury ◽

Nerve Graft ◽

Nerve Transfers ◽

Obstetric Brachial Plexus ◽

Graft Reconstruction ◽

Obstetric Brachial Plexus Injury

Download Full-text

Prolonged brachial plexus neuropathy: a rare complication following protracted endometriosis surgery in Lloyd-Davies position

BMJ Case Reports ◽

10.1136/bcr-2021-243408 ◽

2021 ◽

Vol 14 (11) ◽

pp. e243408

Author(s):

Anna Katrina Hay ◽

Anna McDougall ◽

Peter Hinstridge ◽

Sanjeev Rajakuldendran ◽

Wai Yoong

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Injury ◽

Rare Complication ◽

Patient Positioning ◽

Sensory Innervation ◽

Plexus Brachialis ◽

Clinical Anatomy ◽

Reduction Strategies ◽

Risk Reduction Strategies ◽

Endometriosis Surgery

Brachial plexus injury is a rare but potentially serious complication of laparoscopic surgery. Loss of motor and/or sensory innervation can have a significant impact on the patient’s quality of life following otherwise successful surgery. A 38-year-old underwent elective laparoscopic management of severe endometriosis during which she was placed in steep head-down tilt Lloyd-Davies position for a prolonged period. On awakening from anaesthesia, the patient had no sensation or movement of her dominant right arm. A total plexus brachialis injury was suspected. As advised by a neurologist, an MRI brachial plexus, nerve conduction study and electromyography were requested. She was managed conservatively and made a gradual recovery with a degree of residual musculocutaneous nerve neuropathy. The incidence of brachial plexus injury following laparoscopy is unknown but the brachial plexus is particularly susceptible to injury as a result of patient positioning and prolonged operative time. Patient positioning in relation to applied clinical anatomy is explored and risk reduction strategies described.

Download Full-text