Use of intercostal nerves for neurotization of the musculocutaneous nerve in infants with birth-related brachial plexus palsy

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Object. The use of intercostal nerves (ICNs) for the neurotization of the musculocutaneous nerve (MCN) in adult patients with traumatic brachial plexus palsy has been well described. However, its use for brachial plexus palsy in infants has rarely been reported. The authors surgically created 31 ICN—MCN communications for birth-related brachial plexus palsy and present the surgical results.

Methods. Thirty-one neurotizations of the MCN, performed using ICNs, were conducted in 30 patients with birth-related brachial plexus palsy. In most cases other procedures were combined to reconstruct all upper-extremity function. The mean patient age at surgery was 5.8 months and the mean follow-up period was 5.2 years. Intercostal nerves were transected 1 cm distal to the mammary line and their stumps were transferred to the axilla, where they were coapted directly to the MCN. Two ICNs were used in 26 cases and three ICNs in five cases.

The power of the biceps muscle of the arm was rated Grade M4 in 26 (84%) of 31 patients. In the 12 patients who underwent surgery when they were younger than 5 months of age, all exhibited a grade of M4 (100%) in their biceps muscle power. These results are better than those previously reported in adults.

Conclusions. Neurotization of the MCN by surgically connecting ICNs is a safe, reliable, and effective procedure for reconstruction of the brachial plexus in patients suffering from birth-related palsy.

Article Information

Address reprint requests to: Hidehiko Kawabata, M.D., Department of Orthopaedic Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka 594–1101, Japan. email: hk@mch.pref.osaka.jp.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Photographs demonstrating the operative procedure. Upper: Skin incision. Center: Dissection of an ICN after transverse incision into the rib periosteum. Lower: Surgically created nerve communication between ICNs and MCN.

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    Graph depicting surgery results plotted against patient age at operation. The standard British Research Council Muscle Movement Scale was used to determine muscle power (see text for details). n = number of patients.

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    Graph depicting surgical results plotted against type of injury. The standard British Research Council Muscle Movement Scale was used to determine muscle power (see text for details).

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    Photographs of a patient obtained 2.5 years after he underwent surgery for bilateral Erb palsy. This boy had been born in the breech position. Surgical creation of ICN—MCN communications were performed when the patient was 7 months (right side) and 8 months (left side) of age. Note the independent flexion of both right and left elbows.

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