Muscle Transfer From Triceps to Biceps in Patients With Chronic Injury of the Upper Trunk of the Brachial Plexus

Abstract

Objective: To evaluate the results from transposition of the triceps for elbow flexion in patients with chronic and complete injury to the upper trunk of the brachial plexus. Methods: This was a retrospective study, including only patients who had biceps grade 0 and triceps grade 5, who underwent anterior transfer of the triceps muscle, performed between 1998 and 2005. The affected side, sex, type of accident, strength of elbow flexion, complications and patient satisfaction were investigated in 11 cases. Results: 10 patients were male; the age range was from 24 to 49 years, with a mean of 33.7 years. The minimum time between injury and surgery was 21 months (range 21-74 months). The left side was affected in eight cases, and the right only in three. Good results were obtained in 10 patients, who acquired elbow flexion strength of grade 3 (two cases) and grade 4 (eight cases), while one evolved unfavorably with grade 2 strength. Two cases had complications (initial compartment syndrome and insufficient tensioning). All the patients said that they were satisfied with the procedure. Conclusion: Anterior transposition of the triceps muscle provided patient satisfaction in all cases except one, attaining strength grade 4 in eight cases, grade 3 in two cases and grade 2 in one case.

Brachial Plexus Injuries – Review of the Anatomy and the Treatment Options

“…With this transfer, good elbow flexion can be achieved after the process of rehabilitation, where the triceps muscle will learn its new function, but the active extension of the elbow will be lost, making this procedure unwanted for patients who depend on using wheelchair or crutches. Good functional result and solid evaluation from the patients are found in most of the cases, except in cases of inadequate tension at the level of the tendon suture line [49].…”

Triceps to biceps transfer for restoration of elbow flexion following upper brachial plexus injury

“…From the results of another study on 11 cases of upper plexus injuries with MRC Grade 4 in 8 MRC Grade 3 in 2 and Grade 2 in 1; the entire triceps was used, but there was no mention about the loss of active elbow extension. [19] In a series of fifty patients using multiple techniques of transfer for elbow flexion in upper brachial plexus injury, the authors did 19 triceps transfers -7 primarily due to delay in presentation and 12 secondary using muscle that had been reinnervated by previous nerve surgeries causing biceps-triceps cocontraction; 9 had very good (>120°, Grade 4), 8 had good (80°-120° Grade 4) and 1 fair (80°-120° Grade 3); there was 1 failure (<80° and/or Grade 3). [4] The technique of triceps transfer is not described, but it is assumed that the whole muscle was transferred on account of the indication of cocontraction.…”

“…From the results of another study on 11 cases of upper plexus injuries with MRC Grade 4 in 8 MRC Grade 3 in 2 and Grade 2 in 1; the entire triceps was used, but there was no mention about the loss of active elbow extension. [ 19 ]…”