Phrenic nerve transfer to the musculocutaneous nerve for the repair of brachial plexus injury: electrophysiological characteristics

Abstract BACKGROUND The phrenic nerve can be transferred to the musculocutaneous nerve using video-assisted thoracoscopy, aiming at the recovery of elbow flexion in patients with traumatic brachial plexus injuries. There are few scientific papers in the literature that evaluate the results of this operative technique. OBJECTIVE To evaluate biceps strength and pulmonary function after the transfer of the phrenic nerve to the musculocutaneous nerve using video-assisted thoracoscopy. METHODS A retrospective study was carried out in a sample composed of 28 patients who were victims of traumatic injury to the brachial plexus from 2008 to 2013. Muscle strength was graded using the British Medical Research Council (BMRC) scale and pulmonary function through spirometry. Statistical tests, with significance level of 5%, were used. RESULTS In total, 74.1% of the patients had biceps strength greater than or equal to M3. All patients had a decrease in forced vital capacity and forced expiratory volume in 1 s, with no evidence of recovery over time. CONCLUSION Transferring the phrenic nerve to the musculocutaneous nerve using video-assisted thoracoscopy may lead to an increase in biceps strength to BMRC M3 or greater in most patients. Considering the deterioration in the parameters of spirometry observed in our patients and the future effects of aging in the respiratory system, it is not possible at the moment to guarantee the safety of this operative technique in the long term.

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Pearls and Pitfalls of Phrenic Nerve Transfer for Shoulder Reconstruction in Brachial Plexus Injury

Journal of Brachial Plexus and Peripheral Nerve Injury ◽

10.1055/s-0041-1722979 ◽

2021 ◽

Vol 16 (01) ◽

pp. e1-e9

Author(s):

Kazuteru Doi ◽

Sei Haw Sem ◽

Bipin Ghanghurde ◽

Yasunori Hattori ◽

Sotetsu Sakamoto

Keyword(s):

Brachial Plexus ◽

Phrenic Nerve ◽

Functional Outcomes ◽

Brachial Plexus Injury ◽

Nerve Transfer ◽

Suprascapular Nerve ◽

Pulmonary Complications ◽

Predisposing Factors ◽

Shoulder Range Of Motion ◽

Shoulder Reconstruction

Abstract Objectives The purpose of this study was to report the functional outcomes of phrenic nerve transfer (PNT) to suprascapular nerve (SSN) for shoulder reconstruction in brachial plexus injury (BPI) patients with total and C5–8 palsies, and its pulmonary complications. Methods Forty-four out of 127 BPI patients with total and C5–8 palsies who underwent PNT to SSN for shoulder reconstruction were evaluated for functional outcomes in comparison with other types of nerve transfers. Their pulmonary function was analyzed using vital capacity in the percentage of predicted value and Hugh-Jones (HJ) breathless classification. The predisposing factors to develop pulmonary complications in those patients were examined as well. Results PNT to SSN provided a better shoulder range of motion significantly as compared with nerve transfer from C5 root and contralateral C7. The results between PNT and spinal accessory nerve transfer to SSN were comparable in all directions of shoulder motions. There were no significant respiratory symptoms in majority of the patients including six patients who were classified into grade 2 HJ breathlessness grading. Two predisposing factors for poorer pulmonary performance were identified, which were age and body mass index, with cut-off values of younger than 32 years old and less than 23, respectively. Conclusions PNT to SSN can be a reliable reconstructive procedure in restoration of shoulder function in BPI patients with total or C5–8 palsy. The postoperative pulmonary complications can be prevented with vigilant patient selection.

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Comparative study of phrenic nerve transfers with and without nerve graft for elbow flexion after global brachial plexus injury

Injury ◽

10.1016/j.injury.2012.12.013 ◽

2014 ◽

Vol 45 (1) ◽

pp. 227-231 ◽

Cited By ~ 16

Author(s):

Yuzhou Liu ◽

Jie Lao ◽

Kaiming Gao ◽

Yudong Gu ◽

Xin Zhao

Keyword(s):

Comparative Study ◽

Brachial Plexus ◽

Phrenic Nerve ◽

Brachial Plexus Injury ◽

Elbow Flexion ◽

Nerve Graft ◽

Nerve Transfers

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Nerve Transfer Is Superior to Nerve Grafting for Suprascapular Nerve Reconstruction in Obstetrical Brachial Plexus Birth Injury: A Meta-Analysis

Hand ◽

10.1177/15589447211030691 ◽

2021 ◽

pp. 155894472110306

Author(s):

Kevin J. Nickel ◽

Alexander Morzycki ◽

Ralph Hsiao ◽

Michael J. Morhart ◽

Jaret L. Olson

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Injury ◽

External Rotation ◽

Nerve Transfer ◽

Suprascapular Nerve ◽

Cochrane Library ◽

Nerve Grafting ◽

Level Of Evidence ◽

Optimal Method ◽

Shoulder External Rotation

Background Restoration of shoulder function in obstetrical brachial plexus injury is paramount. There remains debate as to the optimal method of upper trunk reconstruction. The purpose of this study was to test the hypothesis that spinal accessory nerve to suprascapular nerve transfer leads to improved shoulder external rotation relative to sural nerve grafting. Methods A systematic review of Medline, EMBASE, EBSCO CINAHL, SCOPUS, Cochrane Library, and TRIP Pro from inception was conducted. Our primary outcome was shoulder external rotation. Results Four studies were included. Nerve transfer was associated with greater shoulder external rotation relative to nerve grafting (mean difference: 0.82 AMS 95% confidence interval [CI]: 0.27-1.36, P < .005). Patients undergoing nerve grafting were more likely to undergo a secondary shoulder stabilizing procedure (odds ratio [OR]: 1.27, 95% CI: 0.8376-1.9268). Conclusion In obstetrical brachial plexus injury, nerve transfer is associated with improved shoulder external rotation and a lower rate of secondary shoulder surgery. Level of Evidence Level III; Therapeutic

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

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835519500358 ◽

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.

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