scholarly journals Nerve transfer in brachial plexus traction injuries

2003 ◽  
Vol 60 (5) ◽  
pp. 539-546 ◽  
Author(s):  
Miroslav Samardzic ◽  
Danica Grujicic ◽  
Lukas Rasulic ◽  
Dragoljub Bacetic ◽  
Biljana Milicic
Keyword(s):  
Brachial Plexus ◽  
Nerve Transfer ◽  
Intercostal Nerve ◽  
The Other ◽  
Brachial Plexus Palsy ◽  
Quality Of Recovery ◽  
Nerve Transfers ◽  
Comparative Statistical Analysis

Background. The aim of this study was to analyze the results of nerve transfer to the musculocutaneous and axillary nerves, using some technical modalities such as intercostal, spinal accessory or intraplexal transfer, and on the basis of the results to try to clarify the most common controversies concerning these operations. Methods. The study included 82 patients with brachial plexus traction injuries, who were operated on using various techniques of nerve transfer. The follow-up period was at least two years. The analysis of biceps and deltoid muscles recovery was performed according to the type of the donor nerve. Results. The corresponding rates of recovery for the musculocutaneous and axillary nerves were 46.7% and 68.1% in intercostal nerve transfer, 71.4% and 75% in accessory nerve transfer, 93.1% and 88.8% in nerve transfer of the brachial plexus collateral branches, and 55.5% and 60% in classical intraplexal nerve transfer, respectively. Comparative statistical analysis demonstrated significantly better final outcome and quality of recovery in regional nerve transfers in comparison to the other methods. Conclusion. Our findings suggest that nerve transfer of collateral branches, where possible, (such as in cases with upper or extended upper brachial plexus palsy) might be a method of choice, offering better results and quality of recovery.

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

BRACHIAL PLEXUS PALSY IN NEWBORN INFANTS

PEDIATRICS ◽  
1971 ◽  
Vol 48 (1) ◽  
pp. 18-28
Author(s):  
Gloria D. Eng
Keyword(s):  
Brachial Plexus ◽  
Bone Growth ◽  
Newborn Infants ◽  
The Other ◽  
Brachial Plexus Palsy ◽  
Optimum Treatment ◽  
Growth Dislocation ◽  
Brachial Plexus Paralysis

Experience in the diagnosis, treatment, and evaluation of residua of brachial plexus paralysis in 25 infants is presented. Associated defects substantiate the traumatic nature of the deliveries. The electromyogram proved a valuable tool in the exact delineation of the pathology and in determination of prognosis. Early optimum treatment prevented atrophy and contractures. Of the 20 babies with adequate follow-up, approximately ⅓ recovered by 6 months with minimal deficit, over ½ recovered by 1 year with moderate residua to include persistent weakness, delay in bone growth, dislocation, and peculiar posturing of the arm; and the other three infants showed significant handicaps.

Transfer of Pectoral Nerves to the Musculocutaneous Nerve in Obstetric Upper Brachial Plexus Palsy

Neurosurgery ◽  
2003 ◽  
Vol 53 (2) ◽  
pp. 338-342 ◽  
Author(s):  
Gerhard Blaauw ◽  
Albert C.J. Slooff
Keyword(s):  
Standard Deviation ◽  
Brachial Plexus ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Musculocutaneous Nerve ◽  
Nerve Endings ◽  
Nerve Plexus ◽  
Brachial Plexus Palsy ◽  
Pectoral Nerve

Abstract OBJECTIVE To investigate the results of transfer of pectoral nerves to the musculocutaneous nerve for treatment of obstetric brachial palsy. METHODS In 25 cases of obstetric brachial palsy (20 after breech deliveries), branches of the pectoral nerve plexus were transferred directly to the musculocutaneous nerve. For all patients, the nerve transfer was part of an extended brachial plexus reconstruction. Results were tested both clinically and with the Mallet scale, at a mean follow-up time of 70 months (standard deviation, 34.3 mo). RESULTS There were two complete failures, which were attributable to disconnection of the transferred nerve endings. The results after transfer were excellent in 17 cases and fair in 5 cases. Steindler flexorplasty improved elbow flexion for three patients. CONCLUSION Transfer of pectoral nerves to the musculocutaneous nerve for treatment of obstetric upper brachial palsy may be effective, if the specific anatomic features of the pectoral nerve plexus are sufficiently appreciated.

scholarly journals Intercostal Nerve Transfers to the Musculocutaneous–A Reliable Nerve Transfer for Restoration of Elbow Flexion in Birth-Related Brachial Plexus Injuries

2020 ◽  
Vol 53 (02) ◽  
pp. 254-259
Author(s):  
Alex Muset Lara ◽  
Anil Bhatia ◽  
Jorge Clifton Correa ◽  
Tarek Abdalla El Gammal
Keyword(s):  
Hand Function ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Intercostal Nerve ◽  
Shoulder Function ◽  
Senior Author ◽  
Nerve Transfers ◽  
Intercostal Nerves ◽  
Direct Approximation

Abstract Introduction There is consensus on the need for early microsurgical reconstruction in birth palsies involving three or more roots, that is, extensive partial palsies and total palsies. The fundamental principles of these operations are complete exploration and judicious use of the ruptured stumps by nerve grafting to suitable distal targets. The frequent observation of root avulsions in such cases makes it imperative to look for extraplexual nerve donors for some functions. Intercostal nerves are readily available in such patients. Materials and Methods This is a study of 50 patients of extensive partial and total birth palsies operated upon by the senior author between 1995 and 2010. These included 33 patients with total palsies, 16 patients with near total palsies, and one patient with C56 deficit (operated upon more than 20 years ago). These children were all operated upon between 3 and 6 months of age, except for two patients in whom surgery was delayed till a year due to the phrenic nerve deficit noted at birth. Four intercostal nerves were transferred to the musculocutaneous nerve (MCN) by direct approximation with fibrin glue. Results No respiratory complication was noted from the intercostal harvest. The follow-up ranged from 8 to 20 years (mean 10 years). As many as 48 of the 50 patients regained fully independent elbow flexion. In two cases, the procedure failed completely and had to be salvaged with a free functioning muscle transfer and reuse of the intercostal nerves. Conclusion Intercostal nerve transfers can be relied upon for restoration of elbow flexion in birth palsies. The ruptured roots can then be utilized for augmenting shoulder function in partial palsies or for hand function in total palsies.

NERVE TRANSFER SURGERY FOR ADULT BRACHIAL PLEXUS INJURY

Neurosurgery ◽  
2009 ◽  
Vol 65 (suppl_4) ◽  
pp. A55-A62 ◽  
Author(s):  
Olawale A.R. Sulaiman ◽  
Daniel D. Kim ◽  
Clint Burkett ◽  
David G. Kline
Keyword(s):  
Brachial Plexus ◽  
Research Council ◽  
Medical Research Council ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Nerve Transfers ◽  
Direct Repair ◽  
Grade 3

Abstract OBJECTIVE To review the clinical outcomes in our patients who have undergone nerve transfer operations for brachial plexus reconstruction at the Louisiana State University (LSU) over a 10-year period. A secondary objective is to compare clinical outcomes in patients who had only nerve transfer operations as compared with patients whose nerve transfers were supplemented with direct repair of brachial plexus elements. METHODS Retrospective review of the medical records, imaging, and electrodiagnostic studies (electromyographic and nerve conduction studies) of patients with brachial plexus injuries who underwent nerve transfer operations at LSU over a period of 10 years. RESULTS A total of 81 patients were treated between 1995 to 2005 at the LSU Health Sciences Center; 7 of these patients were lost to follow-up, leaving 74 patients, with an average follow-up of 3.5 years, for review. We evaluated recovery of elbow flexion and shoulder abduction. Ninety percent of patients with medial pectoral to musculocutaneous nerve transfers recovered to LSU grade 2 (Medical Research Council grade 3), and 60% of those patients with intercostal to musculocutaneous nerve transfer regained similar strength in elbow flexion. Shoulder abduction recovery to LSU grade 2 (Medical Research Council grade 3) after spinal accessory to suprascapular and/or thoracodorsal to axillary nerve transfer, was 95% and 36%, respectively. There was a tendency for better motor recovery when nerve transfer operations were combined with direct repair of plexus elements. CONCLUSION Nerve transfers for repair of brachial plexus injuries result in excellent recovery of elbow and shoulder functions. Patients who had direct repair of brachial plexus elements in addition to nerve transfers tended to do better than those who had only nerve transfer operations.

scholarly journals Successful Nerve Transfers for Traumatic Brachial Plexus Palsy in a Septuagenarian

Hand ◽  
2016 ◽  
Vol 11 (4) ◽  
pp. NP30-NP33 ◽  
Author(s):  
Parker H. Johnsen ◽  
Scott W. Wolfe
Keyword(s):  
Brachial Plexus ◽  
Older Patients ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
The Elderly ◽  
Suprascapular Nerve ◽  
Brachial Plexus Palsy ◽  
Nerve Reconstruction ◽  
Post Injury ◽  
Nerve Transfers

Background: Conventional wisdom and the available literature demonstrate compromised outcomes following nerve reconstruction for traumatic brachial plexus palsy in the elderly. We present a 74-year-old male who was reconstructed with multiple nerve transfers for brachial plexus palsy after a ski accident. Methods: Triceps to axillary nerve transfer, spinal accessory to suprascapular nerve transfer, and ulnar to musculocutaneous nerve transfer were performed 16 weeks post injury. Results: At 11 years post-op, the patient could abduct to 65° and forward flex at M4 strength, limited only by painful glenohumeral arthritis. Elbow flexion was M5- at both the biceps and brachialis, and bulk and tone were nearly symmetrical with the opposite side. Eleven-year electrodiagnostic studies demonstrated reinnervation and improved motor unit recruitment all affected muscles. Conclusion: This case questions the widely held dogma that older patients who undergo brachial plexus reconstruction do poorly. Given the short reinnervation distance and optimal donor nerve health, nerve transfers may be an excellent option for healthy older patients with traumatic brachial plexus palsy.

Intercostal nerve transfer in infants with obstetric brachial plexus palsy

Microsurgery ◽  
2008 ◽  
Vol 28 (7) ◽  
pp. 499-504 ◽  
Author(s):  
Tarek A. El-Gammal ◽  
Mohamed M. Abdel-Latif ◽  
Mohamed M. Kotb ◽  
Amr El-Sayed ◽  
Yasser Farouk Ragheb ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Nerve Transfer ◽  
Intercostal Nerve ◽  
Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus Palsy ◽  
Obstetric Brachial Plexus

scholarly journals Nerve Transfers for Restoring Elbow Flexion in Brachial Plexus Palsy

2021 ◽  
Author(s):  
Teodor Stamate ◽  
Dan Cristian Moraru
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Distal Stump ◽  
Brachial Plexus Palsy ◽  
Nerve Transfers ◽  
Pectoral Nerve ◽  
Intercostal Nerves ◽  
Thoracodorsal Nerve

Nerve transfers (NT) consist in sectioning a donor nerve and connecting it to the distal stump of a recipient unrepairable nerve. For elbow flexion restoration in brachial plexus palsy (BPP) we used different NT: 1) GF motor Ulnar Nerve to Biceps nerve (Oberlin technique), 2) Double fascicular median/ulnar to biceps/brachialis nerve transfer (Mackinnon), 3) InterCostal Nerves (ICN) to MCN (+/− nerve graft), 4) Medial Pectoral Nerve (MPN) to MCN, 5) ThoracoDorsal Nerve (TDN) to MCN, 6) Spinal Accessory Nerve (SAN) to MCN transfer, 7) Phrenic Nerve (PhN) to MCN, 8) Cervical Plexus C3-C4 to MCN and 9) Contralateral C7 (CC7). I want to present my personal experience using the phrenic nerve (PhN), the intercostal nerves (ICN) and Oberlin’s technique. The aim of this retrospective study is to evaluate the results of this procedure in BPP. NT is an important goal in BPP. ICN transfer into the nerve of biceps for elbow flexion recovery is a reliable procedure in BPP. ICN transfer for triceps offers a positive alternative (Carroll transposition). Oberlin technique is simple and offers better results in a shorter amount of time and is an effective and safe option.

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