Transfer of the Motor Branch of the Abductor Digiti Quinti for Thenar Muscle Reinnervation in High Median Nerve Injuries

Bertelli, Jayme Augusto; Soldado, Francisco; Rodrígues-Baeza, Alfonso; Ghizoni, Marcos Flávio

doi:10.1016/j.jhsa.2017.08.009

Cited by 37 publications

(33 citation statements)

References 39 publications

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“…Disadvantages to using a nerve transfer are longer time to functional recovery and potential for variable outcomes. 2 Several studies examined the anatomy of the nerve branch to the ADM. 5,8 A single branch was identified in 70% to 80% of cadavers and 2 to 3 branches in the remaining 20% to 30%. The nerve to ADM exits the ulnar side of the ulnar motor branch directly distal to the bifurcation into sensory and motor components and enters the ADM muscle in its proximal third.…”

Section: Discussionmentioning

confidence: 99%

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Restoration of Sensation and Thumb Opposition Using Nerve Transfers Following Resection of a Synovial Sarcoma of the Median Nerve

Power

Fox

Kahn

et al. 2019

Journal of Hand Surgery Global Online

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Synovial sarcomas of peripheral nerves are rare and often leave major functional deficits after wide excision. We present a case of median nerve reconstruction using nerve transfers after resection of a synovial sarcoma of the median nerve. Sensation was restored by transferring the fourth common digital nerve to the first and second common digital nerves. Thumb opposition was restored by transferring the abductor digiti minimi branch to the recurrent motor branch. The soft tissue defect was reconstructed with a free gracilis muscle flap. Fifteen months after surgery, there was Medical Research Council grade 4þ opposition strength with co-contraction of the abductor digiti minimi. Sensation recovered slowly over time. The Disabilities of the Arm, Shoulder, and Hand score decreased from 47.4 before surgery to 13.3 afterward. The patient was able to use the right hand for writing and crafting pottery. Distal nerve transfers are a reliable option for reconstruction of complete median nerve defects.

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Section: Discussionmentioning

confidence: 99%

“…4 A nerve transfer for thumb opposition using a branch to the abductor digiti minimi (ADM) from the ulnar nerve yielded good functional outcomes in 5 patients. 5 We present a case of comprehensive median nerve reconstruction using nerve transfers and free flap coverage after resection of a synovial sarcoma of the median nerve.…”

mentioning

confidence: 99%

Restoration of Sensation and Thumb Opposition Using Nerve Transfers Following Resection of a Synovial Sarcoma of the Median Nerve

Power

Fox

Kahn

et al. 2019

Journal of Hand Surgery Global Online

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“…Transfer of redundant or expendable nerves to the motor branches of denervated muscles has yielded substantial return of movement and motor strength, reversal of atrophy, and patient utility. The advantages of distal nerve transfers over nerve repair or nerve grafting include more rapid recovery of function, limited antagonistic co‐contraction, and the absence of sensory axon to motor target regeneration, among others (Bertelli et al, ; Frank et al, ; MacAvoy & Green, ; Schultz & Aiache, ; Wang et al, ; Wang & Zhu, ).…”

Section: Introductionmentioning

confidence: 99%

“…Nerve transfers distal to the injury have demonstrated substantial success in reanimating denervated muscles (Bertelli, Soldado, Rodrigues-Baeza, & Ghizoni, 2018;Frank et al, 2019;MacAvoy & Green, 2007;Schultz & Aiache, 1972;Wang et al, 2017;Wang & Zhu, 1997). Transfer of redundant or expendable nerves to the motor branches of denervated muscles has yielded substantial return of movement and motor strength, reversal of atrophy, and patient utility.…”

Section: Introductionmentioning

confidence: 99%

“…The advantages of distal nerve transfers over nerve repair or nerve grafting include more rapid recovery of function, limited antagonistic co-contraction, and the absence of sensory axon to motor target regeneration, among others (Bertelli et al, 2018;Frank et al, 2019;MacAvoy & Green, 2007;Schultz & Aiache, 1972;Wang et al, 2017;Wang & Zhu, 1997).…”

Section: Introductionmentioning

confidence: 99%

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Distal nerve transfer for thenar palsy: A cadaveric study

et al. 2020

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Introduction Severe proximal median nerve palsies often result in irreversible thenar atrophy and thumb abduction function loss. Tendon transfer involves substantial limitations and challenges; but, distal nerve transfer may provide an alternative treatment. Our goal was to validate the anatomical suitability of two distal ulnar nerve branches for thenar muscle reanimation. Materials and Methods We assessed nerve transfer to the recurrent branch of median nerve (RMN) in 16 embalmed cadaveric hands. The ulnar motor branch to the flexor digiti minimi brevis (FDMBn) and the ulnar motor branch to the third lumbrical (3rdLn) were assessed for transfer. Coaptation success was measured by the overlap of the nerve donor with the RMN and correspondence of nerve diameters. Results The mean transferable length and width of the RMN were 20.7 ± 4.5 and 1.0 ± 0.3 mm, respectively. We identified an average of three branches in the branching anatomy from the ulnar nerve to the hypothenar muscles. The maximal transferable lengths and widths of the FDMBn and the 3rdLn were 13.8 ± 4.4 and 0.5 ± 0.1 mm and 24.1 ± 6.4 and 0.4 ± 0.1 mm, respectively. The overlap with the RMN of the FDMBn and 3rdLn was 9.0 ± 3.6 (2.0–15.3) and 17.8 ± 6.0 (4.7–27.5) mm, respectively. Conclusions This anatomical study demonstrates the feasibility of distal nerve transfers between the ulnar and median nerves in the hand for reanimation of thenar muscles. Ulnar motor donors of the BrFDMBn and 3rdLn likely represent the least morbid donors with short distances for regeneration and a single coaptation repair.

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Assessment, management, and rehabilitation of traumatic peripheral nerve injuries for non‐surgeons

Bateman,

Pripotnev,

Larocerie‐Salgado

et al. 2024

Muscle and Nerve

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Electrodiagnostic evaluation is often requested for persons with peripheral nerve injuries and plays an important role in their diagnosis, prognosis, and management. Peripheral nerve injuries are common and can have devastating effects on patients' physical, psychological, and socioeconomic well‐being; alongside surgeons, electrodiagnostic medicine specialists serve a central function in ensuring patients receive optimal treatment for these injuries. Surgical intervention—nerve grafting, nerve transfers, and tendon transfers—often plays a critical role in the management of these injuries and the restoration of patients' function. Increasingly, nerve transfers are becoming the standard of care for some types of peripheral nerve injury due to two significant advantages: first, they shorten the time to reinnervation of denervated muscles; and second, they confer greater specificity in directing motor and sensory axons toward their respective targets. As the indications for, and use of, nerve transfers expand, so too does the role of the electrodiagnostic medicine specialist in establishing or confirming the diagnosis, determining the injury's prognosis, recommending treatment, aiding in surgical planning, and supporting rehabilitation. Having a working knowledge of nerve and/or tendon transfer options allows the electrodiagnostic medicine specialist to not only arrive at the diagnosis and prognosticate, but also to clarify which nerves and/or muscles might be suitable donors, such as confirming whether the branch to supinator could be a nerve transfer donor to restore distal posterior interosseous nerve function. Moreover, post‐operative testing can determine if nerve transfer reinnervation is occurring and progress patients' rehabilitation and/or direct surgeons to consider tendon transfers.

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Transfer of the Motor Branch of the Abductor Digiti Quinti for Thenar Muscle Reinnervation in High Median Nerve Injuries

Cited by 37 publications

References 39 publications

Restoration of Sensation and Thumb Opposition Using Nerve Transfers Following Resection of a Synovial Sarcoma of the Median Nerve

Restoration of Sensation and Thumb Opposition Using Nerve Transfers Following Resection of a Synovial Sarcoma of the Median Nerve

Distal nerve transfer for thenar palsy: A cadaveric study

Assessment, management, and rehabilitation of traumatic peripheral nerve injuries for non‐surgeons

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