Reanimation of elbow extension with medial pectoral nerve transfer in partial injuries to the brachial plexus

Clinical article

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  • Unit of Neurosurgery, Hospital de Base do Distrito Federal, and Post-Graduate Program in Medical Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
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Object

Recent advancements in operative treatment of the brachial plexus authorized more extensive repairs and, currently, elbow extension can be included in the rank of desirable functions to be restored. This study aims to describe the author's experience in using the medial pectoral nerve for reinnervation of the triceps brachii in patients sustaining C5–7 palsies of the brachial plexus.

Methods

This is a retrospective study of the outcomes regarding recovery of elbow extension in 12 patients who underwent transfer of the medial pectoral nerve to the radial nerve or to the branch of the long head of the triceps.

Results

The radial nerve was targeted in 3 patients, and the branch to the long head of the triceps was targeted in 9. Grafts were used in 6 patients. Outcomes assessed as Medical Research Council Grades M4 and M3 for elbow extension were noted in 7 (58%) and 5 (42%) patients, respectively.

Conclusions

The medial pectoral nerve is a reliable donor for elbow extension recovery in patients who have sustained C5–7 nerve root injuries.

Abbreviations used in this paper:BLHT = branch of the long head of the triceps; MPN = medial pectoral nerve; MRC = Medical Research Council.

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Contributor Notes

Address correspondence to: Leandro Pretto Flores, Ph.D., SQN 208 Bloco F Apartamento 604, Asa Norte, Brasília, Distrito Federal, Brazil 70853-060. email: leandroprettoflores@hotmail.com.

Please include this information when citing this paper: published online January 4, 2013; DOI: 10.3171/2012.11.JNS111539.

  • 1

    Aszmann OC, , Rab M, , Kamolz L, & Frey M: The anatomy of the pectoral nerves and their significance in brachial plexus reconstruction. J Hand Surg Am 25:942947, 2000

    • Search Google Scholar
    • Export Citation
  • 2

    Belzberg AJ, , Dorsi MJ, , Storm PB, & Moriarity JL: Surgical repair of brachial plexus injury: a multinational survey of experienced peripheral nerve surgeons. J Neurosurg 101:365376, 2004

    • Search Google Scholar
    • Export Citation
  • 3

    Bertelli JA, , Santos MA, , Kechele PR, , Ghizoni MF, & Duarte H: Triceps motor nerve branches as a donor or receiver in nerve transfers. Neurosurgery 61:5 Suppl 2 333339, 2007

    • Search Google Scholar
    • Export Citation
  • 4

    Bhardwaj P, & Bhardwaj N: Motor grading of elbow flexion—is Medical Research Council grading good enough?. J Brachial Plex Peripher Nerve Inj 4:3, 2009. (Letter)

    • Search Google Scholar
    • Export Citation
  • 5

    Doi K, , Shigetomi M, , Kaneko K, , Soo-Heong T, , Hiura Y, & Hattori Y, : Significance of elbow extension in reconstruction of prehension with reinnervated free-muscle transfer following complete brachial plexus avulsion. Plast Reconstr Surg 100:364374, 1997

    • Search Google Scholar
    • Export Citation
  • 6

    Gu YD, , Zhang GM, , Chen DS, , Yan JG, , Cheng XM, & Chen L: Seventh cervical nerve root transfer from the contralateral healthy side for treatment of brachial plexus root avulsion. J Hand Surg Br 17:518521, 1992

    • Search Google Scholar
    • Export Citation
  • 7

    Handling MA, , Curtis AS, & Miller SL: The origin of the long head of the triceps: a cadaveric study. J Shoulder Elbow Surg 19:6972, 2010

    • Search Google Scholar
    • Export Citation
  • 8

    Hentz VR, & Narakas A: The results of microneurosurgical reconstruction in complete brachial plexus palsy. Assessing outcome and predicting results. Orthop Clin North Am 19:107114, 1988

    • Search Google Scholar
    • Export Citation
  • 9

    Kim DH, , Cho YJ, , Tiel RL, & Kline DG: Outcomes of surgery in 1019 brachial plexus lesions treated at Louisiana State University Health Sciences Center. J Neurosurg 98:10051016, 2003

    • Search Google Scholar
    • Export Citation
  • 10

    Kretschmer T, , Ihle S, , Antoniadis G, , Seidel JA, , Heinen C, & Börm W, : Patient satisfaction and disability after brachial plexus surgery. Neurosurgery 65:4 Suppl A189A196, 2009

    • Search Google Scholar
    • Export Citation
  • 11

    Leechavengvongs S, , Witoonchart K, , Uerpairojkit C, & Thuvasethakul P: Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases. J Hand Surg Am 28:633638, 2003

    • Search Google Scholar
    • Export Citation
  • 12

    Lieber RL, , Fridén J, , Hobbs T, & Rothwell AG: Analysis of posterior deltoid function one year after surgical restoration of elbow extension. J Hand Surg Am 28:288293, 2003

    • Search Google Scholar
    • Export Citation
  • 13

    Millesi H: Surgery on muscles in consequence of peripheral nerve lesions. Acta Neurochir Suppl 100:179181, 2007

  • 14

    Millesi H: Surgical management of brachial plexus injuries. J Hand Surg Am 2:367378, 1977

  • 15

    Mumenthaler M: Some clinical aspects of peripheral nerve lesions. Eur Neurol 2:257268, 1969

  • 16

    Narakas A: Brachial plexus surgery. Orthop Clin North Am 12:303323, 1981

  • 17

    Novak CB, & Mackinnon SE: Distal anterior interosseous nerve transfer to the deep motor branch of the ulnar nerve for reconstruction of high ulnar nerve injuries. J Reconstr Microsurg 18:459464, 2002

    • Search Google Scholar
    • Export Citation
  • 18

    Oberlin C, , Béal 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

    • Search Google Scholar
    • Export Citation
  • 19

    Samardzic M, , Grujicic D, , Rasulic L, & Bacetic D: Transfer of the medial pectoral nerve: myth or reality?. Neurosurgery 50:12771282, 2002

    • Search Google Scholar
    • Export Citation
  • 20

    Teboul F, , Kakkar R, , Ameur N, , Beaulieu JY, & Oberlin C: Transfer of fascicles from the ulnar nerve to the nerve to the biceps in the treatment of upper brachial plexus palsy. J Bone Joint Surg Am 86-A:14851490, 2004

    • Search Google Scholar
    • Export Citation
  • 21

    Terzis JK, & Kokkalis ZT: Restoration of elbow extension after primary reconstruction in obstetric brachial plexus palsy. J Pediatr Orthop 30:161168, 2010

    • Search Google Scholar
    • Export Citation
  • 22

    Wellons JC III, , Tubbs RS, , Pugh JA, , Bradley NJ, , Law CR, & Grabb PA: Medial pectoral nerve to musculocutaneous nerve neurotization for the treatment of persistent birth-related brachial plexus palsy: an 11-year institutional experience. Clinical article. J Neurosurg Pediatr 3:348353, 2009

    • Search Google Scholar
    • Export Citation

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