Restoration of active pick-up function in patients with total brachial plexus avulsion injuries

Abstract

IV.

Reconstruction of hook grip function of the fingers in patients with traumatic brachial plexus injury

“…The search for the optimum method of reconstruction continues. Multiple nerve transfer methods for total brachial plexus avulsion injuries have been shown to restore useful upper limb function, including active pick-up and protective sensation (Li et al, 2018;Wang et al, 2013). Their method includes the transfer of the accessory nerve onto the suprascapular nerve, CC7 nerve onto the lower trunk directly, musculocutaneous nerve with interpositional bridging by the medial antebrachial cutaneous nerve arising from the lower trunk and the phrenic nerve onto the posterior division of the lower trunk.…”

“…The patients who achieved useful recovery were selected for secondary reconstruction to restore active pickup. Forty patients achieved finger extension and flexion reached more than M3 in 15 (38%) and 25 (63%) patients, respectively (Li et al, 2018). Only 25% of patients achieved active pick-up function, which is defined as actively touching a target object without the help of the contralateral hand, grabbing it, moving it to another place and putting it down (Li et al, 2018).…”

“…Options for functional restoration in patients with total brachial plexus injury remain limited. In terms of nerve transfer techniques, use of the contralateral C7 (CC7) nerve root (Gu et al, 1992) is well-described with several modifications (Chuang and Hernon, 2012;Li et al, 2018;Wang et al, 2013Wang et al, , 2021 all of which requires sacrifice of the healthy C7 nerve, incurring a 2% risk of severe and long-term donor deficits (Yang et al, 2015). In terms of muscle transfer, Doi et al (2000) described a double free muscle transfer technique that could potentially restore three useful prehensile functions, including elbow flexion, finger extension and finger flexion, with hand sensibility restored by anastomosing the sensory rami of the intercostal nerves to the medial cord.…”

Differences in management and treatment of traumatic adult pan brachial plexus injuries: a global perspective regarding continental variations

“…The primary and secondary reconstructive efforts were agreed to be elbow flexion and shoulder stability. For the remaining functions to be reconstructed, the treatment strategies varied as well as the preferences for use of phrenic nerve and CC7 (Figure 1) (Li et al, 2018;Sammer et al, 2012;Wang and Xue, 2014;Wang et al, 2013Wang et al, , 2016Wang et al, , 2021, FFMT (Figure 2) (Adams et al, 2009;Barrie et al, 2004;Chim et al, 2014;Giuffre et al, 2012;Maldonado et al, 2016aMaldonado et al, , 2017aMaldonado et al, , 2017b, reimplantation of roots into the spinal cord (Figure 3) (Carlstedt, 2009;Carlstedt et al, 2000Carlstedt et al, , 2004Htut et al, 2007) and shoulder arthrodesis.…”

2017 Yearbook of Neurorestoratology

“…Finger flexion [42] or elbow extension [43] can be restored by nerve transfer or biceps-to-triceps transfers for patients with tetraplegia. Nerve transfer also could restore active picking-up function for patients with total brachial plexus avulsion injuries [44]. Zheng et al in a single-center randomized controlled trial reported that transferring the C7 nerve from the nonparalyzed side to the paralyzed side of the arm could leads to greater improvement in function and reduction of spasticity for patients with chronic cerebral injury for more than 5 years [45].…”