Restoration of elbow flexion in adult traumatic brachial plexus injury – a quantitative analysis of results of single versus double nerve transfer

Srampickal, George Mathew; Mathew, Anil; Raveendran, Sreekanth; Yadav, Bijesh; Thomas, Binu P.

doi:10.1016/j.injury.2020.10.090

Cited by 7 publications

(3 citation statements)

References 24 publications

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“…Fasce et al [ 22 ] showed a mean of 135° in shoulder abduction with triple nerve transfers. In comparison to recently reported double nerve transfer procedures to reanimate shoulder abduction [ 14 , 22 ] or elbow flexion [ 23 ], as well as triple or multiple nerve transfers [ 21 , 22 ], our surgical outcome (double nerve transfers with neurolysis and muscle contracture release) was more effective, as it restored all UE functional movements (shoulder abduction and elbow flexion) to nearly normal ( Figure 2A–2C ).…”

Section: Discussionmentioning

confidence: 50%

“…Addressing nerve root injuries in the context of severe cervical spinal cord injuries resulting in complete paralysis of the extremities has been challenging. Distal-targeted nerve transfers have been successfully performed as a preferred alternative to the site of a proximal injury [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] since the regeneration distance will be much shorter and, therefore, the recovery will be faster. Additionally, in cases of iatrogenic surgical injuries at the proximal cervical spinal level (ACDF), as in the present case report, the distal operative area will have no scarring from previous surgeries, allowing for technical precision in reconstructive efforts.…”

Section: Discussionmentioning

confidence: 99%

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Double Fascicular Nerve Transfer Restored Nearly Normal Functional Movements in a Completely Paralyzed Upper Extremity Resulting from an ACDF Surgery: A Case Report and Review of Recent Literature

Nath

Somasundaram

2023

Am J Case Rep

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Unusual clinical course Background:Cervical spine deformities can occur because of genetic, congenital, inflammatory, degenerative, or iatrogenic causes. Case Report:We report a 45-year-old woman who presented to our clinic with complete paralysis of the left upper extremity 5 months after C4-C6 discectomy and fusion surgery. The electrodiagnostic and EMG reports 3 months after her previous surgery revealed left C5-C7 polyradiculopathy involving the upper trunk, lateral and posterior cords, and atrophy of the left deltoids, triceps, and biceps muscles. She underwent the following nerve transfer procedures with the senior author (RKN): The median nerve fascicles were transferred to the biceps and brachialis branches of the musculocutaneous nerve. Radial nerve triceps branches were transferred to the deltoid and teres minor branches of the axillary nerve. The patient could fully abduct her left shoulder to 170°, and the LUE functions were restored to nearly normal 17 months after the surgery. Conclusions:Neurolysis combined with nerve transfer might be the most effective treatment for cervical spinal root injuries. Advances in peripheral nerve rewiring, transcranial magnetic stimulation, brain-computer interface robotic technologies, and emerging rehabilitation will undoubtedly increase the possibility of reviving the extremities in patients with central pathology by restoring the descending motor signals through the residual neural network connections.

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Double Fascicular Nerve Transfer Restored Nearly Normal Functional Movements in a Completely Paralyzed Upper Extremity Resulting from an ACDF Surgery: A Case Report and Review of Recent Literature

Nath

Somasundaram

2023

Am J Case Rep

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“…In general, nerve transfers recover relatively quickly compared to nerve grafts, which is reported to be one of the most important factors in the number of viable motor axons 1,10,12) . This technique allows the transfer of regenerating motor axons very close to the neuromuscular junction of the elbow flexors, minimizing the distance and time required for the regenerating front to reach the target muscle 2,[10][11][12]14) . Therefore, patients with prolonged onset of disease can also be candidates for this procedure.…”

Section: Discussionmentioning

confidence: 99%

Double Fascicular Nerve Transfer to Restore Elbow Flexion Following Neuralgic Amyotrophy: A Case Report

Chung

Yang

Cho

et al. 2022

Nerve

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Double fascicular nerve transfer (DFNT) involves transferring fascicles from the median and ulnar nerves to the musculocutaneous nerve to restore elbow flexion. We performed this procedure on a patient who was diagnosed with neuralgic amyotrophy (NA) 2 years previously. We aimed to investigate the short-term outcomes and feasibility of DFNT applied to non-traumatic neuropathy. A 63-year-old, right-handed man presented to us with persistent right elbow flexion weakness 24 months after receiving the diagnosis of NA. On examination, biceps strength was 0/5, and shoulder abduction strength was 3/5. Magnetic resonance neurography demonstrated muscle atrophy in the upper trunk. DFNT was considered to restore elbow flexion. The donor and recipient fascicles were then coapted (flexor digitorum superficialis to biceps brachii, flexor carpi ulnaris to brachialis). Postoperatively, paresthesia was reported in the area of ulnar innervation, and the patient complained of hand clumsiness. From postoperative day 10 onward, biceps muscle contracture was identified and on the 14th day, grade 3 elbow flexion strength was observed. We suggest that DFNT may be a safe and effective method to restore elbow flexion in patients with NA.

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Improving outcomes in traumatic peripheral nerve injuries to the upper extremity

Zimmermann,

Aman,

Harhaus

et al. 2023

Eur J Orthop Surg Traumatol

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Restoration of elbow flexion in adult traumatic brachial plexus injury – a quantitative analysis of results of single versus double nerve transfer

Cited by 7 publications

References 24 publications

Double Fascicular Nerve Transfer Restored Nearly Normal Functional Movements in a Completely Paralyzed Upper Extremity Resulting from an ACDF Surgery: A Case Report and Review of Recent Literature

Double Fascicular Nerve Transfer Restored Nearly Normal Functional Movements in a Completely Paralyzed Upper Extremity Resulting from an ACDF Surgery: A Case Report and Review of Recent Literature

Double Fascicular Nerve Transfer to Restore Elbow Flexion Following Neuralgic Amyotrophy: A Case Report

Improving outcomes in traumatic peripheral nerve injuries to the upper extremity

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