Nerve transfers for restoration of finger flexion in patients with tetraplegia

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>The purpose of this paper was to report the authors' results with finger flexion restoration by nerve transfer in patients with tetraplegia.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Surgery was performed for restoration of finger flexion in 17 upper limbs of 9 patients (8 male and 1 female) at a mean of 7.6 months (SD 4 months) after cervical spinal cord injury. The patients' mean age at the time of surgery was 28 years (SD 15 years). The motor level according to the ASIA (American Spinal Injury Association) classification was C-5 in 4 upper limbs, C-6 in 10, and C-7 in 3.</jats:p> <jats:p>In 3 upper limbs, the nerve to the brachialis was transferred to the anterior interosseous nerve (AIN), which was separated from the median nerve from the antecubital fossa to the midarm. In 5 upper limbs, the nerve to the brachialis was transferred to median nerve motor fascicles innervating finger flexion muscles in the midarm. In 4 upper limbs, the nerve to the brachioradialis was transferred to the AIN. In the remaining 5 upper limbs, the nerve to the extensor carpi radialis brevis (ECRB) was transferred to the AIN. Patients were followed for an average of 16 months (SD 6 months). At the final evaluation the range of finger flexion and strength were estimated by manual muscle testing according to the British Medical Research Council scale.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Restoration of finger flexion was observed in 4 of 8 upper limbs in which the nerve to the brachialis was used as a donor. The range of motion was incomplete in all 5 of these limbs, and the strength was M3 in 3 limbs and M4 in 1 limb. Proximal retrograde dissection of the AIN was associated with better outcomes than transfer of the nerve to the brachialis to median nerve motor fascicles in the arm. After the nerve to the brachioradialis was transferred to the AIN, incomplete finger flexion with M4 strength was restored in 1 limb; the remaining 3 limbs did not show any recovery. Full finger flexion with M4 strength was demonstrated in all 5 upper limbs in which the nerve to the ECRB was transferred to the AIN. No functional downgrading of elbow flexion or wrist extension strength was observed.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>In patients with tetraplegia, finger flexion can be restored by nerve transfer. Nerve transfer using the nerve to the ECRB as the donor nerve produced better recovery of finger flexion in comparison with nerve transfer using the nerve to the brachialis or brachioradialis.</jats:p></jats:sec>

The Use of Nerve Transfers to Restore Upper Extremity Function in Cervical Spinal Cord Injury

“…Candidacy for nerve transfer surgery has yet to be definitively outlined. Our previous work [9,10,24], as well as contributions from others [6][7][8][11][12][13]25,26], suggest that results after nerve transfer surgery are promising, although studies [27,28] show variable outcomes. This emphasizes the need for careful and comprehensive preoperative patient evaluation using standardized functional assessments to better define surgical candidacy and outcomes of nerve transfer surgery in patients with SCI.…”

Repair of the musculocutaneous nerve using the vagus nerve as donor by helicoid end‐to‐side technique: an experimental study in rats

“…Nerve transfer is a popular treatment modality in total root avulsed brachial plexus injury and also provides far better functional results as compared to tendon or muscle transfer and shoulder arthrodesis (Bertelli, ; Bertelli and Ghizoni, ; Chuang et al, ). A variety of differing nerve transfer sources have been discussed in the literature and utilized clinically.…”

“…Current treatments for BPI include neurolysis, nerve grafts, nerve transfer, and free‐muscle and pedicle‐muscle transfer. Of these, nerve transfer remains one of the most favored treatments for total root avulsion injuries (Bertelli, ; Bertelli and Ghizoni, ; Bhandari et al, ).…”

Novel Uses of Nerve Transfers

“…Restoring the function of these muscles can significantly improve pinch function, and thus, the anterior interosseous nerve serves as a good target for nerve transfer. Two potential options for the donor nerve have emerged, including the brachialis branch of the musculocutaneous nerve and the extensor carpi radialis brevis (ECRB) branch of the radial nerve [1,29,[38][39][40]. The largest series involved 8 nerve transfers using the brachialis branch as the donor and five nerve transfers using the branch to the ECRB as the donor.…”