Functional outcome of nerve transfers for upper-type brachial plexus injuries

Purpose: The purpose of this study was to present the results of treatment using nerve transfers for elbow and shoulder function in patients with upper-type (C5-C7) brachial plexus injuries. Methods: A retrospective review of a single surgeon's experience was done on the results of treatment using nerve transfers for shoulder abduction and external rotation and elbow flexion in nine patients with upper-type brachial plexus injuries from 2005 to 2008. The average age at the time of surgery was 32 years. The average time from injury to surgery was 6.6 months (range, 3-11 months). Two patients had single-nerve transfers from the ulnar nerve to the biceps branch of the musculocutaneous nerve, and seven patients had double-nerve transfers from the ulnar nerve to the biceps branch and from the median nerve to the brachialis branch of the musculocutaneous nerve. All patients had additional nerve transfers of the spinal accessory nerve to the suprascapular nerve for shoulder abduction and external rotation. The average follow-up for all patients was 27.7 months (range, 12-48 months). Results: On latest follow-up, elbow flexion strength of M4 was achieved in eight out of nine patients. The average time to achieve an elbow flexion grade M3 was 7.6 months (range, 5-12 months). The average elbow range of motion was 128 degrees +/- 19 degrees with average elbow flexor strength of 2.7 +/- 1.5 kg. Shoulder abduction and external rotation were achieved in eight out of nine patients (average of 70 degrees perpendicular to 41 degrees and 61 degrees perpendicular to 46 degrees, respectively). Complications include transient sensory abnormalities in four patients and transient motor weakness in one. Conclusion: Nerve transfer procedures can result in functional recovery of the shoulder and elbow function in patients with upper-type brachial plexus injuries. (C) 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.