Sensory abnormalities after the seventh cervical nerve root transfer

Abstract

Twenty-four patients with root avulsion of brachial plexus were treated with the contralateral C7 root transfer. The area of sensory abnormalities was found on the thumb in 20 cases (83.33%), index finger in 14 cases (58.33%), middle finger in 8 cases (33.33%), ring finger in 3 cases (12.5%), little finger in 11 cases (45.83%), on the radial side of forearm in 9 cases (37.5%), thenar area in 12 cases (50%), and hypothenar area in 8 cases (33.33%). No patient had normal sensation after the seventh cervical root transfer. Sensory abnormalities disappeared within 3 months in all except one patient, who still had sensory abnormalities on the tip of index finger for more than 20 months after the operation.

A Systematic Review of Outcomes of Contralateral C7 Transfer for the Treatment of Traumatic Brachial Plexus Injury

“…Fifteen patients in 3 studies did not have complete recovery from sensory abnormality. 9, 15, 30 Eleven patients in 6 studies with motor weakness did not recover by the latest follow-up period. 9, 12, 13, 16, 30, 34 Among them, 3 patients sustained severe motor deficits including loss of hand muscle functions; 2 patients required subsequent tendon transfer.…”

“…9, 12, 13, 15, 16, 30, 34 Seven of them had both sensory and motor function deficits. Fifteen patients in 3 studies did not have complete recovery from sensory abnormality.…”

“…9, 12, 13, 15, 16, 30, 34 Notably, in 2 cases hand muscle weakness was severe enough (≤M3) to affect daily activities, and therefore needed tendon transfer. 9, 30 Intrinsic hand muscles are mostly innervated by C8 and T1, not C7.…”

Outcome of contralateral C7 transfer to two recipient nerves in 22 patients with the total brachial plexus avulsion injury

“…All 22 patients in this report experienced transient paresthesia of the donor hand and weakness of the contralateral healthy limb right after surgery, which was coincident to the previous report …”

Clinical Problem-Solving

“…Magnetic resonance imaging, electrodiagnostic studies, and CT myelography are all critical components of the preoperative evaluation (6). If the diagnosis of root avulsion is established, restorative surgery should be performed at the ear-nerve can be used (in light of the redundancy of the C7 root) to augment recovery, although long sural nerve grafts are required and there is at least some reported risk of injury to the asymptomatic limb's function with this procedure (23). Excellent results have been obtained with distal fascicular transfers, including the use of expendable ulnar and median nerve motor fascicles to re-innervate biceps and brachialis branches of the musculocutaneous nerve (2,24).…”