Double fascicular nerve transfer to the biceps and brachialis muscles after brachial plexus injury: clinical outcomes in a series of 29 cases

Clinical article

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The clinical outcomes of patients with brachial plexus injuries who underwent double fascicular transfer (DFT) using fascicles from the median and ulnar nerves to reinnervate the biceps and brachialis muscles were evaluated.


The authors conducted a retrospective chart review of 29 patients with brachial plexus injuries that were treated with DFT for restoration of elbow flexion. All patients underwent pre- and postoperative clinical evaluation using the Medical Research Council grading system.


The mean patient age was 37 years (range 17–68 years), and there was a mean follow-up of 19 ± 12 months (range 8–68 months). At the most recent follow-up, all but 1 patient (97%) had regained elbow flexion. Eight patients recovered Grade M5, 15 patients recovered Grade M4, and 4 patients recovered Grade M3 elbow flexion strength. There was no evidence of functional deficit in the donor nerve distributions.


Study results demonstrated the reliable restoration of M4–M5 elbow flexion following double fascicular transfer in patients with brachial plexus injuries.

Abbreviations used in this paper: DFT = double fascicular transfer; FCR = flexor carpi radialis; FCU = flexor carpi ulnaris; FDS = flexor digitorum superficialis; LABCN = lateral antebrachial cutaneous nerve; MCN = musculocutaneous nerve; MPN = medial pectoral nerve; MRC = Medical Research Council; TDN = thoracodorsal nerve.

Article Information

Address correspondence to: Susan E. Mackinnon, M.D., Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, Missouri 63110. email:

Please include this information when citing this paper: published online February 25, 2011; DOI: 10.3171/2011.1.JNS10810.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Photograph showing direct end-to-end transfer of an expendable motor fascicle of the median nerve to the biceps branch and an expendable FCU fascicle of the ulnar nerve to the brachialis branch. Inset features the longer view, with a gray box indicating the orientation of the magnified view.

  • View in gallery

    Schematic of the DFT shown photographically in Fig. 1.

  • View in gallery

    One-year follow-up photograph demonstrating excellent reinnervation of the biceps and brachialis muscles.


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