Median to radial nerve transfer for treatment of radial nerve palsy

Case report

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✓The purpose of this study is to report a surgical technique of nerve transfer to restore radial nerve function after a complete palsy due to a proximal injury to the radial nerve. The authors report the case of a patient who underwent direct nerve transfer of redundant or expendable motor branches of the median nerve in the proximal forearm to the extensor carpi radialis brevis and the posterior interosseous branches of the radial nerve. Assessment included degree of recovery of wrist and finger extension, and median nerve function including pinch and grip strength.

Clinical evidence of reinnervation was noted at 6 months postoperatively. The follow-up period was 18 months. Recovery of finger and wrist extension was almost complete with Grade 4/5 strength. Pinch and grip strength were improved postoperatively. No motor or sensory deficits related to the median nerve were noted, and the patient is very satisfied with her degree of functional restoration.

Transfer of redundant synergistic motor branches of the median nerve can successfully reinnervate the finger and wrist extensor muscles to restore radial nerve function. This median to radial nerve transfer offers an alternative to nerve repair, graft, or tendon transfer for the treatment of radial nerve palsy.

Abbreviations used in this paper:AIN = anterior interosseous nerve; ECRB = extensor carpi radialis brevis; ECRL = extensor carpi radialis longus; FCR = flexor carpi radialis; FDS = flexor digitorum sublimis; PIN = posterior interosseous nerve; PL = palmaris longus.

Article Information

Address reprint requests to: Susan E. Mackinnon, M.D., Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Suite 5401, 660 South Euclid Avenue, St. Louis, Missouri 63110. email:

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    Illustration of transfer of redundant FDS and FCR/PL branches of the median nerve in the proximal forearm to the ECRB and posterior interosseous branches of the radial nerve through a single proximal volar forearm incision.

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    Radiograph of the patient's right upper extremity following placement of an intramuscular rod for the humeral fracture.

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    Intraoperative photographs. Upper: Dissection of motor branches of the right median nerve through the proximal volar forearm incision (elbow to the right, and hand to the left). A indicates the FCR/PL branch; B, the median nerve (proximal to the AIN branch); C, the FDS branch; and D, the pronator teres branch. Lower: The FDS and FCR/PL branches (black arrow) of the median nerve are divided distally and transposed laterally toward the ECRB, and posterior interosseous branches of the radial nerve (white arrow) are divided proximally prior to direct end-to-end co-aptation.

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    Photographs taken at 1-year follow-up demonstrating restoration of finger and wrist extension of the right hand.

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    Illustrations. The tenodesis effect refers to the length–tension relationship between wrist position and the extrinsic flexors of the fingers. Wrist extension increases the passive tension of the flexor tendons and thereby passively causes finger flexion and increases flexion strength, whereas wrist flexion has the opposite effect and allows the digits to passively extend.



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