Physiological and clinical advantages of median nerve fascicle transfer to the musculocutaneous nerve following brachial plexus root avulsion injury

Rahul K. Nath M.D.1, Andrew B. Lyons B.Sc.1, and Gabriel Bietz B.Sc.1
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  • 1 Texas Nerve and Paralysis Institute, Houston, Texas
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Object

Loss of biceps muscle function is a significant disability after brachial plexus root avulsion injuries. Nerve grafting techniques to reestablish anatomical and functional continuity between the spinal cord and the avulsed root have not proven successful. Using nerve transfers for functional restoration of root avulsion injuries appears to be effective and has physiological advantages for reducing regeneration distances. Since the early 1990s, the Oberlin technique of transferring ulnar nerve fascicles to the motor branch of the musculocutaneous nerve has been the preferred operative technique for reinnervation and restoration of biceps muscle function. In the current study the authors examine the efficacy of an alternative technique using median nerve fascicles transferred to the musculocutaneous nerve to reinnervate the biceps muscle.

Methods

Forty consecutive patients with combined C5–6 brachial plexus root avulsions were evaluated pre- and postoperatively according to the British Medical Research Council Motor Grading Scale. Personal interviews concerning quality of life (QOL) after surgery were conducted and scored based on standards set by the World Health Organization. All patients showed some degree of improvement in biceps muscle function. Thirty-six (90%) of the 40 patients regained movement against gravity. The patients had a 77% improvement in overall QOL after the surgery; most notably, 92% of the patients reported their lack of need for medication and 75% a significant lessening of postoperative pain. Redirection of part of the healthy median nerve resulted in no measurable functional deficits, and only 28 patients reported minor sensory disturbances in the first web space for an average of 3 months after surgery.

Conclusions

Median nerve fascicle transfer resulted in a significant improvement in biceps muscle function with an acceptable level of morbidity and should be considered an effective, and in many cases preferable, alternative to ulnar nerve fascicle transfer.

Abbreviations used in this paper:

MRC = Medical Research Council; QOL = quality of life.

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  • 1

    Al-Qattan MM: Oberlin’s ulnar nerve transfer to the biceps nerve in Erb’s birth palsy. Plast Reconstr Surg 109:405407, 2002

  • 2

    Chuang DC, , Lee GW, , Hashem F, & Wei FC: Restoration of shoulder abduction by nerve transfer in avulsed brachial plexus injury: evaluation of 99 patients with various nerve transfers. Plast Reconstr Surg 96:122128, 1995

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Mackinnon SE, & Dellon AL: Surgery of the Peripheral Nerve New York, Thieme Medical Publishers, 1988

  • 4

    Mackinnon SE, & Novak CB: Nerve transfers. New options for reconstruction following nerve injury. Hand Clin 15:643666, 1999

  • 5

    Mennen U: End-to-side nerve suture in clinical practice. Hand Surg 8:3342, 2003

  • 6

    Midha R: Nerve transfers for severe brachial plexus injuries: a review. Neurosurg Focus 16:5 E5, 2004

  • 7

    Nath RK, & Mackinnon SE: Nerve transfers in the upper extremity. Hand Clin 16:131139, 2000

  • 8

    Noaman HH, , Shiha AE, & Bahm J: Oberlin’s ulnar nerve transfer to the biceps motor nerve in obstetric brachial plexus palsy: indications, and good and bad results. Microsurgery 24:182187, 2004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Oberlin C, , Beal D, , Leechavengvongs S, , Salon A, , Dauge MC, & Sarcy JJ: Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg [Am] 19:232237, 1994

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Rasulic L, , Samardzic M, , Grujicic D, & Bascarevic V: [Nerve transfer in brachial plexus injuries—comparative analysis of surgical procedures.]. Acta Chir Iugosl 50:3346, 2003. (Serbian)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Seddon H: Surgical Disorders of the Peripheral Nerves New York, Churchill Livingstone, 1975

  • 12

    Sunderland S: The intraneural topography of the radial, median and ulnar nerves. Brain 68:243249, 1945

  • 13

    Tung TH, , Novak CB, & Mackinnon SE: Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries. J Neurosurg 98:313318, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Williams HB, & Jabaley ME: The importance of internal anatomy of the peripheral nerves to nerve repair in the forearm and hand. Hand Clin 2:689707, 1986

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    World Health Organization Division of Mental Health: WHOQOL-BREF (http://www.who.int/evidence/assessment-instruments/qol/documents/WHOQOL_BREF.pdf) [Accessed 4 October 2006]

    • Search Google Scholar
    • Export Citation

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