scholarly journals Median to radial nerve transfer after traumatic radial nerve avulsion in a pediatric patient

2019 ◽  
Vol 24 (2) ◽  
pp. 209-214 ◽  
Author(s):  
Ellen L. Larson ◽  
Katherine B. Santosa ◽  
Susan E. Mackinnon ◽  
Alison K. Snyder-Warwick
Keyword(s):  
Pediatric Patient ◽  
Radial Nerve ◽  
Sensory Nerve ◽  
Nerve Transfer ◽  
Orthopedic Procedures ◽  
Pronator Teres ◽  
Nerve Transfers ◽  
Muscle Groups ◽  
Flexor Digitorum ◽  
Extensor Carpi Radialis

This case report describes an isolated radial nerve avulsion in a pediatric patient, treated by combination sensory and motor median to radial nerve transfers. After traumatic avulsion of the proximal radial nerve, a 12-year-old male patient underwent end-to-end transfer of median nerve branches to flexor carpi radialis and flexor digitorum superficialis to the posterior interosseous nerve and extensor carpi radialis nerve, respectively. He underwent end-to-side sensory transfer of the superficial radial sensory to the median sensory nerve. Pronator teres to extensor carpi radialis brevis tendon transfer was simultaneously performed to power short-term wrist extension. Within months after surgery, the patient had regained 9–10/10 sensation in the hand and forearm. In the following months and years, he regained dexterity, independent fine-finger and thumb motions, and 4–5/5 strength in all extensors except the abductor pollicis longus muscle. He grew 25 cm without extremity deformity or need for secondary orthopedic procedures. In appropriate adult and pediatric patients with proximal radial nerve injuries, nerve transfers have advantages over tendon transfers, including restored independent fine finger motions, regained sensation, and reinnervation of multiple muscle groups with minimal donor sacrifice.

Transfer of the Distal Terminal Motor Branch of the Extensor Carpi Radialis Brevis to the Nerve of the Flexor Pollicis Longus

Neurosurgery ◽  
2011 ◽  
Vol 70 (4) ◽  
pp. 1011-1016 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Vera Lúcia Mendes Lehm ◽  
Cristiano Paulo Tacca ◽  
Elisa Cristiana Winkelmann Duarte ◽  
Marcos Flávio Ghizoni ◽  
...  
Keyword(s):  
Tendon Graft ◽  
Flexor Digitorum Profundus ◽  
Orthopedic Procedures ◽  
Flexor Pollicis Longus ◽  
Motor Branch ◽  
Nerve Transfers ◽  
Finger Flexion ◽  
Distal Branch ◽  
Flexor Digitorum ◽  
Extensor Carpi Radialis

Abstract BACKGROUND: In tetraplegics, thumb and finger motion traditionally has been reconstructed via orthopedic procedures. Although rarely used, nerve transfers are a viable method for reconstruction in tetraplegia. OBJECTIVE: To investigate the anatomic feasibility of transferring the distal branch of the extensor carpi radialis brevis (ECRB) to the flexor pollicis longus (FPL) nerve and to report our first clinical case. METHODS: We studied the motor branch of the ECRB and FPL in 14 cadaveric upper limbs. Subsequently, a 24-year-old tetraplegic man with preserved motion in his shoulder, elbow, wrist, and finger extension, but paralysis of thumb and finger flexion underwent surgery. Seven months after trauma, we transferred the brachialis muscle with a tendon graft to the flexor digitorum profundus. The distal nerve of the ECRB was transferred to the FPL nerve. RESULTS: The branch to the ECRB entered the muscle in its anterior and proximal third. After sending out a first collateral, the nerve runs for 2.4 cm alongside the muscle and bifurcates intramuscularly. A main branch from the anterior interosseous nerve, which entered the muscle 3 cm from its origin on the radius, innervated the FPL. The ECRB and FPL nerves had similar diameters (∼1 mm) and numbers of myelinated fibers (∼180). In our patient, 14 months after surgery, pinching and grasping were restored and measured 2 and 8 kg strength, respectively. CONCLUSION: Transfer of the ECRB distal branch to the FPL is a viable option to reconstruct thumb flexion.

Radial Nerve Palsy: Nerve Transfer Versus Tendon Transfer to Restore Function

Hand ◽  
2021 ◽  
pp. 155894472098812
Author(s):  
J. Megan M. Patterson ◽  
Stephanie A. Russo ◽  
Madi El-Haj ◽  
Christine B. Novak ◽  
Susan E. Mackinnon
Keyword(s):  
Radial Nerve ◽  
Tendon Transfer ◽  
Nerve Palsy ◽  
Nerve Transfer ◽  
Pinch Strength ◽  
Radial Nerve Palsy ◽  
Nerve Injuries ◽  
Tendon Transfers ◽  
Nerve Transfers ◽  
Transfer Group

Background: Radial nerve injuries cause profound disability, and a variety of reconstruction options exist. This study aimed to compare outcomes of tendon transfers versus nerve transfers for the management of isolated radial nerve injuries. Methods: A retrospective chart review of 30 patients with isolated radial nerve injuries treated with tendon transfers and 16 patients managed with nerve transfers was performed. Fifteen of the 16 patients treated with nerve transfer had concomitant pronator teres to extensor carpi radialis brevis tendon transfer for wrist extension. Preoperative and postoperative strength data, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and quality-of-life (QOL) scores were compared before and after surgery and compared between groups. Results: For the nerve transfer group, patients were significantly younger, time from injury to surgery was significantly shorter, and follow-up time was significantly longer. Both groups demonstrated significant improvements in grip and pinch strength after surgery. Postoperative grip strength was significantly higher in the nerve transfer group. Postoperative pinch strength did not differ between groups. Similarly, both groups showed an improvement in DASH and QOL scores after surgery with no significant differences between the 2 groups. Conclusions: The nerve transfer group demonstrated greater grip strength, but both groups had improved pain, function, and satisfaction postoperatively. Patients who present early and can tolerate longer time to functional recovery would be optimal candidates for nerve transfers. Both tendon transfers and nerve transfers are good options for patients with radial nerve palsy.

scholarly journals Anatomical feasibility of performing intercostal and ilioinguinal nerve to pelvic nerve transfer: a possible technique to restore lower urinary tract innervation

2012 ◽  
Vol 17 (4) ◽  
pp. 357-362 ◽  
Author(s):  
Justin M. Brown ◽  
Mary F. Barbe ◽  
Michael E. Albo ◽  
H. Henry Lai ◽  
Michael R. Ruggieri
Keyword(s):  
Nerve Transfer ◽  
Pilot Project ◽  
Canine Model ◽  
Anatomical Location ◽  
Detrusor Muscle ◽  
Pelvic Nerve ◽  
Cross Sectional ◽  
Ilioinguinal Nerve ◽  
Nerve Transfers ◽  
Muscle Groups

Object Nerve transfers are effective for restoring control to paralyzed somatic muscle groups and, recently, even to denervated detrusor muscle in a canine model. A pilot project was performed in cadavers to examine the feasibility of transferring somatic nerves to vesical branches of the pelvic nerve as a method for potentially restoring innervation to control the detrusor muscle in humans. Methods Eleven cadavers were dissected bilaterally to expose intercostal, ilioinguinal, and iliohypogastric nerves, along with vesical branches of the pelvic nerve. Ease of access and ability to transfer the former 3 nerves to the pelvic vesical nerves were assessed, as were nerve cross-sectional areas. Results The pelvic vesical nerves were accessed at the base of the bladder, inferior to the ureter and accompanied by inferior vesical vessels. The T-11 and T-12 intercostal nerves were too short for transfer to the pelvic vesical nerves without grafting. Ilioinguinal and iliohypogastric nerves (L-1 origin) were identified retroperitoneally and, with full dissection, were easily transferred to the pelvic vesical nerves intraabdominally. The mean cross-sectional area of the dominant pelvic vesical branch was 2.60 ± 0.169 mm2; ilioinguinal and iliohypogastric branches at the suggested transection site were 2.38 ± 0.32 mm2 (the means are expressed ± SEM). Conclusions Use of the ilioinguinal or iliohypogastric nerves for heterotopic transfer to pelvic vesical nerves is surgically feasible, based on anatomical location and cross-sectional areas.

Functional restoration after early tendon transfer in high radial nerve paralysis

2010 ◽  
Vol 36 (2) ◽  
pp. 135-140 ◽  
Author(s):  
V. Dabas ◽  
T. Suri ◽  
P. K. Surapuraju ◽  
S. Sural ◽  
A. Dhal
Keyword(s):  
Radial Nerve ◽  
Tendon Transfer ◽  
Hand Function ◽  
Precision Grip ◽  
Functional Restoration ◽  
Nerve Paralysis ◽  
Power Grip ◽  
Pronator Teres ◽  
Junction Site ◽  
Extensor Carpi Radialis

We assessed the effect of an early transfer of pronator teres to extensor carpi radialis brevis on hand function in patients with high radial nerve paralysis. Power grip and precision grip were measured preoperatively and postoperatively using a dynamometer. Fifteen patients were operated on, of which ten could be assessed at the end of 6 months. At 6 months after surgery, there was a median increase of 48% in power grip, 162% in tip pinch, 90% in key pinch and 98% in palmar pinch. Decreased palmar flexion was seen in four patients. Fraying of the periosteal extension and rupture of sutures at the junction site were each seen in one patient, leading to unsatisfactory results. Early tendon transfer quickly restored efficient grip while awaiting reinnervation of wrist extensors, avoiding the need for prolonged external splintage.

The Innervation Pattern of the Radial Nerve at the Elbow and in the Forearm

1998 ◽  
Vol 23 (2) ◽  
pp. 167-169 ◽  
Author(s):  
G. BRANOVACKI ◽  
M. HANSON ◽  
R. CASH ◽  
M. GONZALEZ
Keyword(s):  
Radial Nerve ◽  
Sensory Nerve ◽  
Extensor Digitorum ◽  
Sensory Nerves ◽  
Posterior Interosseous Nerve ◽  
Extensor Pollicis Longus ◽  
Abductor Pollicis Longus ◽  
Extensor Carpi Ulnaris ◽  
Wide Variability ◽  
Extensor Carpi Radialis

Sixty paired cadaver forearms were dissected to examine the distribution of the radial nerve branches to the muscles at the elbow and forearm. Emphasis was placed on the innervation of the extensor carpi radialis brevis and the supinator muscles because of discrepancies in the literature concerning these muscles. The most common branching pattern (from proximal to distal) was to brachioradialis, extensor carpi radialis longus, superficial sensory, extensor carpi radialis brevis, supinator, extensor digitorum/extensor carpi ulnaris, extensor digiti minimi, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus and extensor indicis. The branch to extensor digitorum and extensor carpi ulnaris came off as a common stem often with the branch to extensor digiti minimi. The branch to the ECRB muscle was noted to arise from the posterior interosseous nerve in 45%, superficial sensory nerve in 25% and at the bifurcation of the posterior interosseous and superficial sensory nerves in 30% of specimens. The supinator had an average of 2.3 branches from the posterior interosseous nerve (range 1–6). The branches to the supinator showed a wide variability proximal to and within the supinator.

scholarly journals Median to Radial Nerve Transfer to Restore Wrist and Finger Extension: Technical Nuances

2010 ◽  
Vol 66 (suppl_1) ◽  
pp. ons-75-ons-83 ◽  
Author(s):  
Justin M. Brown ◽  
Thomas H.H. Tung ◽  
Susan E. Mackinnon
Keyword(s):  
Radial Nerve ◽  
Nerve Palsy ◽  
Nerve Transfer ◽  
Radial Nerve Palsy ◽  
Tendon Transfers ◽  
Line Drawings ◽  
Nerve Transfers ◽  
Finger Extension ◽  
Reconstructive Option ◽  
Distal Nerve

Abstract Background: Traditional methods for restoring finger and wrist extension following radial nerve palsy include interposition nerve grafting or tendon transfers. We have described the utilization of distal nerve transfers for the restoration of radial nerve function in the forearm. Objective: We review the neuroanatomy of the forearm and outline the steps required for the implementation of this transfer. Methods And Results: We use a step-by-step procedural outline and detailed photographs, line drawings, and video to describe the procedure. Conclusion: This approach is technically feasible and is a reconstructive option for patients with this nerve deficit.

Nerve Transfers From Branches to the Flexor Carpi Radialis and Pronator Teres to Reconstruct the Radial Nerve

2014 ◽  
Vol 39 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Antonio García-López ◽  
Ramón Navarro ◽  
Francisco Martinez ◽  
Adaly Rojas
Keyword(s):  
Radial Nerve ◽  
Flexor Carpi Radialis ◽  
Pronator Teres ◽  
Nerve Transfers

scholarly journals Sensory Nerve Transfer for Lower Roots Brachial Plexus Injury: Superficial Radial Nerve to the Dorsal Cutaneous Branch and the Superficial Branch of the Ulnar Nerve

2019 ◽  
Vol 11 (03) ◽  
pp. 178-180
Author(s):  
Feiran Wu ◽  
Chye Yew Ng
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Radial Nerve ◽  
Brachial Plexus Injury ◽  
Donor Site ◽  
Sensory Nerve ◽  
Nerve Transfer ◽  
Superficial Radial Nerve ◽  
Superficial Branch ◽  
Cutaneous Branch

AbstractIn the treatment of brachial plexus injury to lower nerve roots, the priority is to restore motor function to the paralyzed hand. In addition, it is also important to consider sensory reconstruction, which is crucial to the optimal restoration of prehensile function. We report the surgical technique and sensory recovery of a nerve transfer in a case in which the superficial radial nerve was transferred to the dorsal cutaneous branch and the superficial branch of the ulnar nerve in a patient with C7, C8, and T1 roots injury. The nerve transfer successfully restored sensation in the ulnar one and a half digits as well as the ulnar border of the hand, with minimal donor site deficit. This technique provides a useful sensory reconstructive option in patients with brachial plexus injury to lower roots.

Tendon transfer for radial nerve palsy: a single tendon to restore finger extension as well as thumb extension/radial abduction

2012 ◽  
Vol 37 (9) ◽  
pp. 855-862 ◽  
Author(s):  
M. M. Al-Qattan
Keyword(s):  
Radial Nerve ◽  
Tendon Transfer ◽  
Nerve Palsy ◽  
Radial Nerve Palsy ◽  
Wrist Movement ◽  
Pronator Teres ◽  
Finger Extension ◽  
A Prospective Study ◽  
Extensor Carpi Radialis

Since 1994, the author has been treating irreparable radial nerve palsy with pronator teres to the extensor carpi radialis brevis (for wrist extension) and a single tendon (flexor carpi radialis or ulnaris) transfer to restore finger extension as well as thumb extension/radial abduction. We sought to investigate whether these patients are able to flex the fingers with the thumb in abduction/extension posture. This was a prospective study over a 5-year period, and the results of this transfer in 15 consecutive patients (mean age 28 years) were analyzed. At final follow-up (mean 30 months), all patients had reasonable wrist movement, finger extension, and thumb extension/radial abduction. The overall results were rated excellent in 12 patients and good in the remaining three patients according to the Bincaz scale. More interesting was the ability of all patients to flex their fingers with only mild relaxation of the extended/abducted thumb.

Triceps Motor Nerve Branches as a Donor or Receiver in Nerve Transfers

2007 ◽  
Vol 61 (suppl_5) ◽  
pp. ONS333-ONS339 ◽  
Author(s):  
Jayme A. Bertelli ◽  
Marcos A. Santos ◽  
Paulo R. Kechele ◽  
Marcos F. Ghizoni ◽  
Hamilton Duarte
Keyword(s):  
Radial Nerve ◽  
Latissimus Dorsi ◽  
Motor Nerve ◽  
Nerve Transfer ◽  
Motor Branch ◽  
Medial Head ◽  
Nerve Transfers ◽  
Axillary Region ◽  
Long Head ◽  
Lateral Head

AbstractObjective:The pattern of triceps innervation is complex and, as yet, has not been fully elucidated. The purposes of this study were 1) to clarify the anatomy of the triceps motor branches, and 2) to evaluate their possible uses as a donor or receiver for nerve transfer.Methods:The radial nerve and its motor and cutaneous branches were bilaterally dissected from the axilla and posterior arm regions of 10 embalmed cadavers.Results:A single branch innervates the triceps long head, whereas double innervation was identified for the lateral and medial heads. The upper branch to the lateral head originated from the radial nerve, whereas the lower branch to the lateral head stemmed from the lower medial head motor branch, which ultimately innervated the anconeus muscle. Both the long head and the upper medial head motor branches originated in the axillary region in the vicinity of the latissimus dorsi tendon.Conclusion:Each of the triceps’ motor branches might be used as a donor for transfer. The triceps long head motor branch should be used preferentially when the intention is to establish triceps reinnervation.

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