Multiple nerve and tendon transfers: a new strategy for restoring hand function in a patient with C7–T1 brachial plexus avulsions

Abstract

C7-T1 brachial plexus palsies result in a loss of finger motion and hand function. The authors have observed that finger flexion motion can be recovered after a brachialis motor branch transfer. However, finger flexion strength after this procedure merely corresponds to Medical Research Council Grades M2-M3, lowering the grip strength and practical value of the reconstructed hand. Therefore, they used 2 donor nerves and accomplished double nerve transfers for stronger finger flexion. In a patient with a C7-T1 brachial plexus injury, they transferred the pronator teres branch to the anterior interosseous nerve and the brachialis motor branch to the flexor digitorum superficialis branch for reinnervation of full finger flexors. Additionally, the supinator motor branch was transferred for finger extension, and the brachioradialis muscle was used for thumb opposition recovery. Through this new strategy, the patient could successfully accomplish grasping and pinching motions. Moreover, compared with previous cases, the patient in the present case achieved stronger finger flexion and grip strength, suggesting practical improvements to the reconstructed hand.

Lesiones del plexo braquial en adultos: Una revisión narrativa de la literatura

“…Esto puede hacerse con transferencias nerviosas o tendinosas. Estudios recientes 35,36 han demostrado buenos resultados de las transferencias nerviosas de ramas del braquial para los nervios interóseo anterior y pronador redondo, o del supinador para el nervio interóseo posterior en caso de ser necesario. 3) Lesión global del plexo preganglionar: son las lesiones traumáticas del plexo, de peor pronóstico.…”

“…Existen diferentes alternativas de tratamiento reportadas en la literatura. Las estrategias más usadas son la transferencia del nervio espinal accesorio al nervio supraescapular, 36 la transferencia de nervios intercostales al nervio musculocutáneo, y el colgajo libre del grácil para otorgar función de mano. 22 38…”

Co-innervation of triceps brachii muscle with variant branch of ulnar nerve

“…in diameter). The diameter and the length of the variant nerve branch (Table I) seem to be sufficient for nerve transfers such as thenar branches of the median nerve or anterior-posterior interosseous nerves (1,10). The postoperative motor deficit of the medial head of the triceps brachii will be less pronounced due to dual innervation from the radial nerve in terms of nerve transfers.…”

Nerves transfers for functional hand recovery in traumatic lower brachial plexopathy

“…In recent years, attention has been focused on tendon transfer, [18,20] free muscle transfer, [3,11] nerve transfer, [5,8,10,13,19,22,30] and combined procedures. [34] In nerve transfer, also known as neurotization, several nerve donors are used for brachialis plexus reconstruction. A nerve transfer involves the coaptation of a healthy, redundant donor nerve to a denervated receptor nerve, restoring the function of the recipient muscle.…”