Evidence for efficacy of new developments in reconstructive upper limb surgery for tetraplegia

Abstract

Nerve transfers are increasingly utilized for upper limb reconstruction in tetraplegia. We reviewed the literature for results achieved by nerve transfers for elbow extension, wrist control and finger and thumb flexion and extension. Muscle strength grading was the only outcome measure consistently reported. The results confirm that nerve transfers can effectively reanimate muscles in selected cases, with comparable strength with those achieved with tendon transfer for elbow extension but inferior strength for finger and thumb flexion. Transfer of supinator nerve branches to the posterior interosseous nerve appears to be reliable and offers increased span and better hand opening than is observed after tendon transfers. Only one publication demonstrated how reinnervation of muscles with nerve transfers translated into improved function, activity and participation for patients. More prospective studies, using standardized outcome measures, are needed to define the precise role of nerve transfers.

Functional outcome after transfer of brachialis on anterior interosseous and supinator on posterior interosseous nerves: A preliminary report

“…Moreover, extension at the first carpometacarpal joint was restored in 11 of the 14 patients who underwent nerve transfer, while this occurred in just 4 of the 13 patients following tendon transfer. Additional advantages of supinator to PIN transfer have been pointed out by other authors (Fridén & Lieber, 2019; Ledgard & Gschwind, 2020): patients achieved more natural fingers opening than after EDC tendon transfers; in addition, reinnervation of the ECU increases strength of wrist extension and prevents radial deviation of the wrist which may occur with tendon transfers (Bertelli, 2020; Ledgard & Gschwind, 2020). On the other hand, the role of nerve transfer in restoring finger flexion and pinch function is less established ad and results are often not uniform among all fingers (Bertelli & Ghizoni, 2012); furthermore, comparative studies are lacking.…”

Selective transfer of nerve to supinator to restore digital extension in central cord syndrome: An anatomical study and a case report

“…Nerve transfers have gained popularity in spinal cord patients (Khalifeh et al, 2019; Ledgard & Gschwind, 2020; Mooney et al, 2020) after the first report of NS transfer to the PIN (Bertelli et al, 2010). They offer several advantages over tendon transfers including preservation of biomechanics, maintaining the force and excursion of the native tendon, as well as no need for prolonged immobilization required for tendon transfers.…”

“…Nerve transfers have gained popularity in spinal cord patients (Khalifeh et al, 2019;Ledgard & Gschwind, 2020;Mooney et al, 2020) after the first report of NS transfer to the PIN (Bertelli et al, 2010).…”

Improving hand function after spinal cord injury

“…Nerve transfer surgery has expanded reconstructive options for restoration of function in the upper extremity after SCI by adding new motor donors to the pool already available through tendon transfer surgery (Ledgard and Gschwind, 2020). This expands the number of functions that can be reconstructed, provides a nerve transfer alternative to traditional tendon transfer reconstructions while keeping those tendon transfer donors intact for add-ons and salvage and enables reanimation of elbow extension, wrist extension and grasp/pinch in higher levels of SCI (Khalifeh et al, 2019;Titolo et al, 2019;van Zyl et al, 2019).…”