Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries

2003 ◽  
Vol 98 (2) ◽  
pp. 313-318 ◽  
Author(s):  
Thomas H. Tung ◽  
Christine B. Novak ◽  
Susan E. Mackinnon
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Elbow Flexion ◽  
Musculocutaneous Nerve ◽  
Content Type ◽  
Nerve Transfers ◽  
Nerve Fascicle ◽  
The Mean ◽  
Flexion Strength ◽  
Fine Print

Object. In this study the authors evaluated the outcome in patients with brachial plexus injuries who underwent nerve transfers to the biceps and the brachialis branches of the musculocutaneous nerve. Methods. The charts of eight patients who underwent an ulnar nerve fascicle transfer to the biceps branch of the musculocutaneous nerve and a separate transfer to the brachialis branch were retrospectively reviewed. Outcome was assessed using the Medical Research Council (MRC) grade to classify elbow flexion strength in conjunction with electromyography (EMG). The mean patient age was 26.4 years (range 16–45 years) and the mean time from injury to surgery was 3.8 months (range 2.5–7.5 months). Recovery of elbow flexion was MRC Grade 4 in five patients, and Grade 4+ in three. Reinnervation of both the biceps and brachialis muscles was confirmed on EMG studies. Ulnar nerve function was not downgraded in any patient. Conclusions. The use of nerve transfers to reinnervate the biceps and brachialis muscle provides excellent elbow flexion strength in patients with brachial plexus nerve injuries.

Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries

2004 ◽  
Vol 16 (5) ◽  
pp. 313-318
Author(s):  
Thomas H. Tung ◽  
Christine B. Novak ◽  
Susan E. Mackinnon
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Elbow Flexion ◽  
Musculocutaneous Nerve ◽  
Nerve Transfers ◽  
Brachialis Muscle ◽  
Nerve Fascicle ◽  
The Mean ◽  
Mean Time ◽  
Flexion Strength

Object In this study the authors evaluated the outcome in patients with brachial plexus injuries who underwent nerve transfers to the biceps and the brachialis branches of the musculocutaneous nerve. Methods The charts of eight patients who underwent an ulnar nerve fascicle transfer to the biceps branch of the musculocutaneous nerve and a separate transfer to the brachialis branch were retrospectively reviewed. Outcome was assessed using the Medical Research Council (MRC) grade to classify elbow flexion strength in conjunction with electromyography (EMG). The mean patient age was 26.4 years (range 16–45 years) and the mean time from injury to surgery was 3.8 months (range 2.5–7.5 months). Recovery of elbow flexion was MRC Grade 4 in five patients, and Grade 4+in three. Reinnervation of both the biceps and brachialis muscles was confirmed on EMG studies. Ulnar nerve function was not downgraded in any patient. Conclusions The use of nerve transfers to reinnervate the biceps and brachialis muscle provides excellent elbow flexion strength in patients with brachial plexus nerve injuries.

Contralateral motor rootlets and ipsilateral nerve transfers in brachial plexus reconstruction

2004 ◽  
Vol 101 (5) ◽  
pp. 770-778 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Marcos Flávio Ghizoni
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Phrenic Nerve ◽  
Cranial Nerve ◽  
External Rotation ◽  
Elbow Flexion ◽  
Content Type ◽  
Nerve Transfers ◽  
Contralateral Motor ◽  
Fine Print

Object. The goal of this study was to evaluate outcomes in patients with brachial plexus avulsion injuries who underwent contralateral motor rootlet and ipsilateral nerve transfers to reconstruct shoulder abduction/external rotation and elbow flexion. Methods. Within 6 months after the injury, 24 patients with a mean age of 21 years underwent surgery in which the contralateral C-7 motor rootlet was transferred to the suprascapular nerve by using sural nerve grafts. The biceps motor branch or the musculocutaneous nerve was repaired either by an ulnar nerve fascicular transfer or by transfer of the 11th cranial nerve or the phrenic nerve. The mean recovery in abduction was 90° and 92° in external rotation. In cases of total palsy, only two patients recovered external rotation and in those cases mean external rotation was 70°. Elbow flexion was achieved in all cases. In cases of ulnar nerve transfer, the muscle scores were M5 in one patient, M4 in six patients, and M3+ in five patients. Elbow flexion repair involving the use of the 11th cranial nerve resulted in a score of M3+ in five patients and M4 in two patients. After surgery involving the phrenic nerve, two patients received a score of M3+ and two a score of M4. Results were clearly better in patients with partial lesions and in those who were shorter than 170 cm (p < 0.01). The length of the graft used in motor rootlet transfers affected only the recovery of external rotation. There was no permanent injury at the donor sites. Conclusions. Motor rootlet transfer represents a reliable and potent neurotizer that allows the reconstruction of abduction and external rotation in partial injuries.

Minimum Ten-Year Outcomes of Partial Ulnar Nerve Transfer for Restoration of Elbow Flexion in Patients with Upper Brachial Plexus Injury

2019 ◽  
Vol 24 (03) ◽  
pp. 283-288
Author(s):  
Yusuke Nagano ◽  
Daisuke Kawamura ◽  
Alaa Terkawi ◽  
Atsushi Urita ◽  
Yuichiro Matsui ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Functional Outcomes ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
The Mean ◽  
Flexion Strength

Background: Partial ulnar nerve transfer to the biceps motor branch of the musculocutaneous nerve (Oberlin’s transfer) is a successful approach to restore elbow flexion in patients with upper brachial plexus injury (BPI). However, there is no report on more than 10 years subjective and objective outcomes. The purpose of this study was to clarify the long-term outcomes of Oberlin’s transfer based on the objective evaluation of elbow flexion strength and subjective functional evaluation of patients. Methods: Six patients with BPI who underwent Oberlin’s transfer were reviewed retrospectively by their medical records. The mean age at surgery was 29.5 years, and the mean follow-up duration was 13 years. The objective functional outcomes were evaluated by biceps muscle strength using the Medical Research Council (MRC) grade at preoperative, postoperative, and final follow-up. The patient-derived subjective functional outcomes were evaluated using the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at final follow-up. Results: All patients had MRC grade 0 (M0) or 1 (M1) elbow flexion strength before operation. Four patients gained M4 postoperatively and maintained or increased muscle strength at the final follow-up. One patient gained M3 postoperatively and at the final follow-up. Although one patient achieved M4 postoperatively, the strength was reduced to M2 due to additional disorder. The mean score of QuickDASH was 36.5 (range, 7–71). Patients were divided into two groups; three patients had lower scores and the other three patients had higher scores of QuickDASH. Conclusions: Oberlin’s transfer is effective in the restoration of elbow flexion and can maintain the strength for more than 10 years. Patients with upper BPI with restored elbow flexion strength and no complicated nerve disorders have over ten-year subjective satisfaction.

Elbow flexion strength and contractile activity after partial ulnar nerve or intercostal nerve transfers for brachial plexus injuries

2020 ◽  
Vol 45 (8) ◽  
pp. 818-826
Author(s):  
Dawn Sinn Yii Chia ◽  
Kazuteru Doi ◽  
Yasunori Hattori ◽  
Sotetsu Sakamoto
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Muscle Power ◽  
Contractile Activity ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Intercostal Nerve ◽  
Nerve Transfers ◽  
Forearm Muscles ◽  
Flexion Strength

We compared the outcomes of 23 partial ulnar nerve and 15 intercostal nerve transfers for elbow flexion reconstruction in patients with C56 or C567 brachial plexus injuries using manual muscle power, dynamometric measurements of elbow flexion strength and electromyography. The range of elbow flexion and muscle strength recovery to Grade 3 or 4 were comparable between the two groups. The patients with C567 injuries had significantly stronger eccentric contraction after the partial ulnar nerve transfer than after the intercostal nerve transfer ( p < 0.05). Electromyography of individual muscles demonstrated that the patients with partial ulnar nerve transfers were unable to voluntarily isolate biceps contraction and recruited forearm flexors and extensors. The patients after partial ulnar nerve transfer had significantly more activity of the forearm muscles during concentric elbow flexion than after intercostal nerve transfers ( p < 0.05). We conclude that partial ulnar nerve transfers were superior to intercostal nerve transfers when assessed quantitatively with the dynamometer to evaluate elbow flexion, although simultaneous recruitment of forearm muscles may have contributed to the increased elbow flexion strength in the patients with the partial ulnar nerve transfer. Level of evidence: III

Use of intercostal nerves for neurotization of the musculocutaneous nerve in infants with birth-related brachial plexus palsy

2001 ◽  
Vol 94 (3) ◽  
pp. 386-391 ◽  
Author(s):  
Hidehiko Kawabata ◽  
Toru Shibata ◽  
Yoshito Matsui ◽  
Natsuo Yasui
Keyword(s):  
Brachial Plexus ◽  
Muscle Power ◽  
Musculocutaneous Nerve ◽  
Biceps Muscle ◽  
Brachial Plexus Palsy ◽  
Content Type ◽  
Age At Surgery ◽  
The Mean ◽  
Intercostal Nerves ◽  
Fine Print

Object. The use of intercostal nerves (ICNs) for the neurotization of the musculocutaneous nerve (MCN) in adult patients with traumatic brachial plexus palsy has been well described. However, its use for brachial plexus palsy in infants has rarely been reported. The authors surgically created 31 ICN—MCN communications for birth-related brachial plexus palsy and present the surgical results. Methods. Thirty-one neurotizations of the MCN, performed using ICNs, were conducted in 30 patients with birth-related brachial plexus palsy. In most cases other procedures were combined to reconstruct all upper-extremity function. The mean patient age at surgery was 5.8 months and the mean follow-up period was 5.2 years. Intercostal nerves were transected 1 cm distal to the mammary line and their stumps were transferred to the axilla, where they were coapted directly to the MCN. Two ICNs were used in 26 cases and three ICNs in five cases. The power of the biceps muscle of the arm was rated Grade M4 in 26 (84%) of 31 patients. In the 12 patients who underwent surgery when they were younger than 5 months of age, all exhibited a grade of M4 (100%) in their biceps muscle power. These results are better than those previously reported in adults. Conclusions. Neurotization of the MCN by surgically connecting ICNs is a safe, reliable, and effective procedure for reconstruction of the brachial plexus in patients suffering from birth-related palsy.

scholarly journals Reinnervation of the biceps in C5–7 brachial plexus avulsion injuries: results after distal bypass surgery

2004 ◽  
Vol 16 (5) ◽  
pp. 1-4 ◽  
Author(s):  
Stefano Ferraresi ◽  
Debora Garozzo ◽  
Paolo Buffatti
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Hand Function ◽  
Elbow Flexion ◽  
Musculocutaneous Nerve ◽  
Biceps Muscle ◽  
Nerve Transfers ◽  
Significant Difference ◽  
Normal Hand ◽  
Nerve Dysfunction

Object The authors report various techniques, and their results, after performing median and ulnar nerve transfers to reanimate the biceps muscle in C5–7 avulsion-related brachial plexus injuries (BPIs). Methods Forty-three adult patients with BPIs of the upper-middle plexus underwent reinnervation of the biceps muscle; neurotization of the musculocutaneous nerve was performed using fascicles from the ulnar nerve (39 cases) and the median nerve (four cases). The different techniques included sectioning, rerouting, and direct suturing of the entire musculocutaneous nerve (35 cases); direct reinnervation of the motor branches of the musculocutaneous nerve (three cases); and reinnervation using small grafts to the motor fascicles that enter the biceps muscle (five cases). Elbow flexion recovery ranged from M2 to M4+, according to the patient's age and the level of integrity of the hand. No surgery-related failure occurred. No significant difference in outcome was related to any of the technical variants. In patients younger than age 45 years and exhibiting a normal hand function a score of M4 or better was always achieved. On average, reinnervation occurred 6 months after surgery. There was no clinical evidence of donor nerve dysfunction. Conclusions When accurate selection criteria are met, the results after this type of neurotization have proved excellent.

Brachial plexus injury: factors affecting functional outcome in spinal accessory nerve transfer for the restoration of elbow flexion

2003 ◽  
Vol 98 (2) ◽  
pp. 307-312 ◽  
Author(s):  
Amir Samii ◽  
Gustavo Adolpho Carvalho ◽  
Madjid Samii
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Elbow Flexion ◽  
Nerve Graft ◽  
Musculocutaneous Nerve ◽  
Accessory Nerve ◽  
Time Interval ◽  
Content Type ◽  
The Impact ◽  
Fine Print

Object. Between 1994 and 1998, 44 nerve transfers were performed using a graft between a branch of the accessory nerve and musculocutaneous nerve to restore the flexion of the arm in patients with traumatic brachial plexus injuries. A retrospective study was conducted, including statistical evaluation of the following pre- and intraoperative parameters in 39 patients: 1) time interval between injury and surgery; and 2) length of the nerve graft used to connect the accessory and musculocutaneous nerves. Methods. The postoperative follow-up interval ranged from 23 to 84 months, with a mean ± standard deviation of 36 ± 13 months. Reinnervation of the biceps muscle was achieved in 72% of the patients. Reinnervation of the musculocutaneous nerve was demonstrated in 86% of the patients who had undergone surgery within the first 6 months after injury, in 65% of the patients who had undergone surgery between 7 and 12 months after injury, and in only 50% of the patients who had undergone surgery 12 months after injury. A statistical comparison of the different preoperative time intervals (0–6 months compared with 7–12 months) showed a significantly better outcome in patients treated with early surgery (p < 0.05). An analysis of the impact of the length of the interposed nerve grafts revealed a statistically significant better outcome in patients with grafts 12 cm or shorter compared with that in patients with grafts longer than 12 cm (p < 0.005). Conclusions. Together, these results demonstrated that outcome in patients who undergo accessory to musculocutaneous nerve neurotization for restoration of elbow flexion following brachial plexus injury is greatly dependent on the time interval between trauma and surgery and on the length of the nerve graft used.

Brachial plexus neurotization with donor phrenic nerves and its effect on pulmonary function

2002 ◽  
Vol 96 (3) ◽  
pp. 523-526 ◽  
Author(s):  
Wolf Luedemann ◽  
Michael Hamm ◽  
Ulrike Blömer ◽  
Madjid Samii ◽  
Marcos Tatagiba
Keyword(s):  
Pulmonary Function ◽  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Vital Capacity ◽  
Musculocutaneous Nerve ◽  
Content Type ◽  
Functional Parameters ◽  
Nerve Transfers ◽  
The Right ◽  
Fine Print

Object. To examine possible side effects of neurotizations in which the phrenic nerve was used, pulmonary function was analyzed pre- and postoperatively in patients with brachial plexus injury and root avulsions. Methods. Twenty-three patients with complete brachial plexus palsy underwent neurotization of the musculocutaneous nerve, with the phrenic nerve as donor material. Patients who suffered lung contusions as part of the primary injury were excluded from this study. In 12 patients (five left-sided and seven right-sided neurotizations) pre- and postoperative functional parameters were compared and additional body plethysmography was performed more than 12 months postsurgery. Of the 23, no patient experienced pulmonary problems postoperatively. Nonetheless, pulmonary functional parameters showed a vital capacity in percent of the predicted value of 9.8 ± 6.3% (mean ± standard deviation [SD]) in all patients examined, which was a significant reduction (p = 0.0002). In right-sided phrenic nerve transfers this reduction was significant, at 14.3 ± 3.3% (mean ± SD), whereas left-sided transfers showed a nonsignificant reduction of 3.6 ± 3.5% (mean ± SD). The observed decrease in vital capacity (VC) correlates with the maximal inspiratory pressure (Pimax) as an indication of clinical significance. Conclusions. When the right phrenic nerve is used as a donor in neurotization of the musculocutaneous nerve, the patient incurs a higher risk of reduced pulmonary VC. If possible, the left phrenic nerve should be preferred. The Pimax has to be determined preoperatively to avoid any further decrease in the already reduced pulmonary function due to the initial injury.

Evaluation of intercostal to musculocutaneous nerve transfer in reconstructive brachial plexus surgery

1998 ◽  
Vol 88 (2) ◽  
pp. 266-271 ◽  
Author(s):  
Martijn J. A. Malessy ◽  
Ralph T. W. M. Thomeer
Keyword(s):  
Brachial Plexus ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Musculocutaneous Nerve ◽  
Accessory Nerve ◽  
Reconstructive Procedure ◽  
Content Type ◽  
Intercostal Nerves ◽  
Brachial Plexus Surgery ◽  
Fine Print

Object. Direct coaptation of intercostal nerves (ICNs) to the musculocutaneous (MC) nerve was performed to restore elbow flexion in 25 patients with brachial plexus root avulsions. Methods. Seventy-five ICNs were transected as close as possible to the sternum to obtain sufficient length and then tunneled to the axilla and coapted to the MC nerve. Direct coaptation was achieved in 95% of ICNs, and functional elbow flexion was regained in 64% of the patients. The results were compared with several reported transfer techniques in which either an ICN or other donor nerves were used. Conclusions. Direct coaptation was equally effective and more straightforward than transfers involving interposition of grafts. The use of alternative donors such as the accessory nerve carries inherent disadvantages compared with the use of ICNs, and the results are not substantially better. Direct ICN—MC nerve transfer is a valuable reconstructive procedure.

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