Delayed Transfer of the Extensor Carpi Radialis Brevis Branch of the Radial Nerve to the Anterior Interosseous Nerve for Restoration of Thumb and Index Finger Flexion: Case Report

Abstract

High median nerve injuries (HMNIs) are rare lesions involving the upper extremities and affect the median nerve from its origin to the emergence of the anterior interosseous nerve (AIN). Proximal reconstruction has long been considered the gold standard in treating HMNI, but thumb and index flexion and pinch and grip weakness are consistently not recovered. We report the surgical results of a patient affected by an HMNI with partial spontaneous recovery after a gunshot wound. AIN function was successfully restored in a delayed fashion by transferring the radial nerve branch to the extensor carpi radialis brevis to the AIN.

Plasticity of the Central Nervous System Involving Peripheral Nerve Transfer

“…Modern concepts of plasticity should also be considered when performing antagonist nerve transfer (the donor and receptor nerves innervating the antagonistic muscles). In patients with proximal median and ulnar nerve injury, transferring the radial nerve branch innervating the extensor carpi radialis brevis to the anterior interosseous nerve can bring about the recovery of full finger and thumb flexion with muscle strength reaching M4 [ 81 , 82 ]. Pronator quadratus to extensor carpi radialis brevis muscle motor branch nerve transfer can yield a 90% success rate for the reconstruction of wrist extension scored M4 in patients with C5-8 brachial plexus palsy [ 83 – 85 ].…”