Clinical use of supinator motor branch transfer to the posterior interosseous nerve in C7–T1 brachial plexus palsies

Adult post traumatic Brachial plexus injury is unfortunately a rather common injury in young adults. In India the most common scenario is of a young man injured in a motorcycle accident. Exact incidence figures are not available but of the injuries presenting to us about 90% invole the above combination This article reviews peer-reviewed publications including clinical papers, review articles and Meta analysis of the subject. In addition, the authors′ experience of several hundred cases over the last 15 years has been added and has influenced the ultimate text. Results have been discussed and analysed to get an idea of factors influencing final recovery. It appears that time from injury and number of roots involved are most crucial.

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“…[5556] Figure 4 shows a result of authors′ case of Nerve to Brachialis transfer to Median Nerve in a late presentation of a lower plexus injury.…”

Section: Distal Nerve Transfersmentioning

confidence: 99%

Brachial plexus injury in adults: Diagnosis and surgical treatment strategies

Thatte

Babhulkar

Hiremath

2013

Ann Indian Acad Neurol

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“…This helps to recover the function of the extensor pollicis longus (EPL) and extensor digitorum communis (EDC) muscles. It is a very successful nerve transfer [137][138][139].…”

Section: Wrist and Finger Extensionmentioning

confidence: 99%

Nerve Transfers in the Treatment of Peripheral Nerve Injuries

Vanaclocha‐Vanaclocha¹,

Ortiz-Criado²,

NievesSáiz-Sapena³

et al. 2017

Peripheral Nerve Regeneration - From Surgery to New Therapeutic Approaches Including Biomaterials and Cell-Based Therapies Deve

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Successful re-innervation of proximal limb peripheral nerve injuries is rare. Axons regenerate at ~1 mm/day, reaching hand muscles by 24 months, finding them atrophied and fibrosed. Peripheral nerve injury repair is often delayed waiting for spontaneous recovery. This waiting time should not be longer than 6 months as after 18 months reinnervation will not achieve effective muscular function. When spontaneous recovery is impossible, referral too late or damage too severe, other options like a transfer from a nearby healthy nerve to the injured one must be considered. They are very successful, and the deficit in the donor site is usually minimal. The most common nerve transfers are a branch of the spinal nerve to the trapezius muscle to the suprascapular nerve, a branch of the long head of the triceps to the axillary nerve, a fascicle of the ulnar nerve to the motor branch of the biceps muscle, two branches of the median nerve to the posterior interosseous nerve and the anterior interosseous nerve to the ulnar nerve. There are many more options that can suit particular cases. Introduced in brachial plexus injury repair, they are now also applied to lower limb, to stroke and to some spinal cord injuries.

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“…Since October 2007, supinator motor branch transfer to the PIN has been successfully used in our clinic. 4 This method has proved reliable, effective, and prompt in restoring finger and thumb extension. It was beneficial even in a delayed case in which the operative interval between trauma and surgery exceeded 15 months, because of the short regeneration distance between the motor donor nerve and its recipient.…”

Section: Finger Extensionmentioning

confidence: 99%

“…The patients could not only extend all metacarpophalangeal joints and the interphalangeal joint of the thumb, but they also had M3 recovery of the extensor carpi ulnaris muscle. The preoperative radial deviation of the wrist was therefore corrected 4 with recovery of the extensor carpi ulnaris muscle, which could become a tendon donor in a late-stage reconstruction. Since this distal neurotization technique offers the opportunity for recovery 3 6 9 12 15 18 21 24 30 1 EDC 0 0 1 2 2 3 3 3 3 ECU 0 0 0 1 2 2 3 3 3 EPL 0 0 0 0 1 2 3 3 3 FPL 0 0 0 1 1 1 2 3 3 FDP (index) 0 0 0 1 1 1 2 3 3 2 EDC 0 1 1 3 3 …”

Section: Finger Extensionmentioning

confidence: 99%

“…Since October 2007, we have performed brachialis motor branch transfer to the anterior interosseous nerve (AIN) coupled with supinator motor branch transfer to the posterior interosseous nerve (PIN) in this group of patients with the aim of restoring finger and thumb flexion and extension. 4 Recovery was satisfactory; however, a hand with merely finger flexion and extension but no thumb opposition was not a genuinely useful hand. Therefore, we combined tendon transfer techniques to restore thumb opposition to further improve hand function.…”

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confidence: 99%

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Restoration of hand function in C7–T1 brachial plexus palsies using a staged approach with nerve and tendon transfer

Zhang

Dong²,

Gu³

2014

JNS

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Brachial plexus palsies of C7-T1 result in the complete loss of hand function, including finger and thumb flexion and extension as well as intrinsic muscle function. The task of reanimating such a hand remains challenging, and so far there has been no reliable neurological reconstructive method for restoring hand function. The authors aimed to establish a reliable strategy to reanimate the paralyzed hand. Two patients had sustained C7-T1 complete lesions. In the first stage of the operative procedure, a supinator motor branch to posterior interosseous nerve transfer was performed with brachialis motor branch transfer to the median nerve to restore finger and thumb extension and flexion. In the second stage, the intact brachioradialis muscle was used for abductorplasty to restore thumb opposition. Both patients regained good finger extension and flexion. Thumb opposition was also attained, and overall hand function was satisfactory. The described strategy proved effective and reliable in restoring hand function after C7-T1 brachial plexus palsies.

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Clinical use of supinator motor branch transfer to the posterior interosseous nerve in C7–T1 brachial plexus palsies

Abstract: A supinator motor branch to posterior interosseous nerve transfer leads to reliable recovery of thumb and finger extension. Therefore, it is a viable option for C7-T1 brachial plexus palsies.

Cited by 31 publications

References 7 publications

Brachial plexus injury in adults: Diagnosis and surgical treatment strategies

Brachial plexus injury in adults: Diagnosis and surgical treatment strategies

Nerve Transfers in the Treatment of Peripheral Nerve Injuries

Restoration of hand function in C7–T1 brachial plexus palsies using a staged approach with nerve and tendon transfer

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