Clinical use of supinator motor branch transfer to the posterior interosseous nerve in C7–T1 brachial plexus palsies

Clinical article

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Object

In C7–T1 brachial plexus palsies, finger extension and flexion are absent. At the authors' institution, finger flexion has been successfully reconstructed by transferring the brachialis motor branch to the anterior interosseous nerve. However, there is no reliable method for restoring finger extension. In the present study, the authors examined the surgical results of transferring the supinator motor branch to the posterior interosseous nerve.

Methods

Since October 2007, the authors have performed a supinator motor branch transfer to the posterior interosseous nerve in 4 patients. The patients underwent follow-up every 3–4 months postoperatively.

Results

Finger extension appeared between 5 and 9 months in the first 3 cases and demonstrated promising improvement over time. One recent case remains under follow-up.

Conclusions

A supinator motor branch to posterior interosseous nerve transfer leads to reliable recovery of thumb and finger extension. Therefore, it is a viable option for C7–T1 brachial plexus palsies.

Abbreviations used in this paper: CMAP = compound motor action potential; EMG = electromyography.

Article Information

Address correspondence to: Cheng-Gang Zhang, M.D., Ph.D., Department of Hand Surgery, Huashan Hospital, Fudan University Medical Center, Shanghai, 200040 China. email: cgzhang@swk.shmu.edu.cn.

Please include this information when citing this paper: published online February 19, 2010; DOI: 10.3171/2010.1.JNS091441.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Drawings of the supinator motor branch transfer to the posterior interosseous nerve. A: The dorsal forearm approach. B: By retracting the extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) aside, the supinator muscle (M) is exposed. C: After dividing the supinator muscle, its motor branches can be identified. The nerve that is looped is a main motor branch and it can be divided and transferred to the posterior interosseous nerve (PIN) without tension.

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    Case 1. Photographs showing the recovery of thumb/finger extension and wrist extension 24 months after transfer of supinator motor branch to posterior interosseous nerve. A: The recovery of thumb and finger extension in his metacarpophalangeal joints is satisfactory. The preoperative radial deviation in wrist extension was corrected due to the reinnervation of the extensor carpi ulnaris. B: The patient can achieve wrist extension in neutral position.

References

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