Nerve transfer in the spastic upper limb: anatomical feasibility study

Waxweiler, Charlotte; Remy, Stéphanie; Merlini, Lorenzo; Leclercq, Caroline

doi:10.1007/s00276-021-02810-w

Cited by 10 publications

(14 citation statements)

References 24 publications

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“…Recently, the team of Waxweiler et al considered this technique in the upper limb [7]. This type of intervention could be of signi cant interest in spastic EVF.…”

Section: Discussionmentioning

confidence: 99%

“…All the procedures currently performed aim to transfer a hypertonic muscle or part of it in order to rebalance its forces to obtain a good inverting balance while maintaining an active dorsal exion. Recently, in the upper limb, teams have been evaluating the nerve transfer of a motor branch of a hypertonic muscle to an inactive muscle [7]. If this transfer concerns two muscles with a combined action, this would allow contraction of the inactive muscle, allowing dynamic rebalancing of the foot.…”

Section: Introductionmentioning

confidence: 99%

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Nerve transfer in the spastic lower limb: anatomical feasibility study

Diner

Pfister

Mourtialon

et al. 2022

Preprint

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PurposeWe want to evaluate the feasibility of transferring a motor branch of the the anterior tibial muscle (ATM) on the extensor digitorum longus (EDL) in order to evaluate this procedure in patients with spastic Equino Varus Foot (EVF) following a post-stroke hemiplegia.MethodsTen cadaveric dissections from five fresh frozen human cadavers were performed in order to establish the anatomic feasibility of transferring a motor branch of the deep peroneal nerve with is usually destinated to the Anterior Tibialis Muscle (ATM) onto the branch of the Extensor Digitorum Longus (EDL), to manage spastic equinovarus foot (SEF). Results Six cases (60%) presented 3 branches detonated to the ATM, one case (10%) presented 5 branches, 3 cases (30%) had 4 branches. In all specimens, the coaptation between the motor branch to the anterior tibial muscle, referred as the ‘effector’ branch, and the branch of the EDL ‘receiver’ branch was feasible without tension and did not require any intra-neural dissection.ConclusionThis anatomical study confirms the feasibility of transferring a motor branch from the ATM to the EDL to correct a spastic EVF.

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“…Recently, the team of Waxweiler et al considered this technique in the upper limb [7]. This type of intervention could be of signi cant interest in spastic EVF.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nerve transfer in the spastic lower limb: anatomical feasibility study

Diner

Pfister

Mourtialon

et al. 2022

Preprint

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“…They advocate for the ECRL instead of the ECRB branch because of its easier identi cation, in specimens where the ECRB branch arises from the deep branch of the radial nerve it can easily be confused with the PIN, or even with the supinator branches. As we mentioned before, Charlotte Waxweiler et al [11] describe the use of ECRL in nerve transfers using a branch from the BR to the ECRL to reduce spasticity and recover extension of the wrist. They found a single motor branch innervating the ECRL in a 70% of the specimens and two branches in a 30% of cases, a lower percentage of redundant innervation of that we found.…”

Section: Discussionmentioning

confidence: 99%

“…Although there is little literature regarding the use of nerve branches to the ECRL in nerve transfers, in the last 10 years some authors reported its potential into this eld according to its anatomical characteristics and easier identi cation in comparison with other alternatives as branches to the ECRB. Charlotte Waxweiler et al [11] describe the use of the branch to the ECRL in nerve transfers from the brachioradialis (BR) to the ECRL in spastic upper limb to reduce spasticity and recover extension of the wrist. Antonio Garcia-López [5] et al described a nerve transfer to restore wrist extension in radial nerve palsy or posterior cord lesions using the pronator teres (PT) branch from the median nerve to the ECRL branch.…”

Section: Introductionmentioning

confidence: 99%

Anatomic study of the innervation of Extensor Carpi Radialis Longus and Extensor Carpi Radialis Brevis. Interest in nerve transfers.

Collado

Español

Espinel

et al. 2022

Preprint

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Purpose: This study pretends to describe the innervation pattern of Extensor Carpi Radialis Longus (ECRL) and Extensor Carpi Radialis Brevis (ECRB) to use ECRL branches as a first choice in nerve transfers to restore flexion and extension of wrist and fingers due to its easier identification and its redundant innervation.Methods: 9 cryopreserved and anonymous specimens were dissected to identify the radial nerve and describe the number of branches, distance between its origin and a line connecting both epicondyles, length of each branch and type of innervation of ECRL and ECRB according to Taylor’s classification.Results: 6 out of 9 specimens presented two branches from the radial nerve to innervate the ECRL (Taylor type 3). 3 out of 9 specimens only had one branch to innervate the ECRL, originating from the radial nerve (two of them classified as a Taylor type 1 and the other as a Taylor type 2). All the specimens had only one branch to innervate the ECRB (eight showing a Taylor type 1 pattern, and one classified as Taylor Type 2); in 7 out of 9 this branch emerges from the deep branch of the radial nerve, emerging in the other 3 specimens from the superficial branch of the radial nerve.Conclusion: The use of the ECRL branches could be considered as the first choice in nerve transfers to restore the flexion and extension of elbow, wrist and fingers in nerve injuries, because of its constant origin after the brachioradialis branch and in most of the cases its redundant innervation.

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“…The branches to BR arise on average 58.3 mm proximal to the bicondylar line (i.e., the line between the medial and lateral epicondyles) and entered the muscle on average 40.1 mm proximal to the bicondylar line. 10 One cadaveric study found 1 to 2 BR branches (1 branch 70% of limbs, 2 branches 30% of limbs), 11 whereas another cadaveric study found 1 to 4 BR branches (1 branch 10%, 2 branches 70%, 3 branches 10%, 4 branches 10%). 10 The branches to ECRL are distal to those of the BR, arising on average 34.6 mm proximal to the bicondylar line and entering the muscle on average 8.4 mm proximal to the bicondylar line.…”

Section: Anatomymentioning

confidence: 99%

Surgical Technique: Brachioradialis to Extensor Carpi Radialis Longus and Brevis Nerve Transfers for Tetraplegia

Long Azad,

Orlando,

Belzberg

et al. 2024

Techniques in Hand &Amp; Upper Extremity Surgery

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Improving upper extremity function in high cervical spinal cord injury (SCI) patients with tetraplegia is a challenging task owing to the limited expendable donor muscles and nerves that are available. Restoring active wrist extension for these patients is critical because it allows for tenodesis grasp. This is classically achieved with brachioradialis (BR) to extensor carpi radialis brevis (ECRB) tendon transfer, but outcomes are suboptimal because BR excursion is insufficient and its origin proximal to the elbow further limits the functionality of the tendon transfer, particularly in the absence of elbow extension. As an alternative approach to restore wrist extension in patients with ICSHT group 1 SCI, we present the first clinical report of the BR to extensor carpi radialis longus (ECRL) and BR to ECRB nerve transfers.

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Nerve transfer in the spastic upper limb: anatomical feasibility study

Cited by 10 publications

References 24 publications

Nerve transfer in the spastic lower limb: anatomical feasibility study

Nerve transfer in the spastic lower limb: anatomical feasibility study

Anatomic study of the innervation of Extensor Carpi Radialis Longus and Extensor Carpi Radialis Brevis. Interest in nerve transfers.

Surgical Technique: Brachioradialis to Extensor Carpi Radialis Longus and Brevis Nerve Transfers for Tetraplegia

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