Double Fascicular Nerve Transfer to Musculocutaneous Branches for Restoration of Elbow Flexion in Brachial Plexus Injury.

• Type of Material: Article
• Authors: Pavlos Texakalidis, Emory University; Muhibullah S Tora, Emory University; Jason Lamanna, Emory University; Jeremy S Wetzel, Emory University; Nicholas Boulis, Emory University
• Language: English
• Date: 2019-04-22
• Publisher: Cureus, Inc.
• Publication Version: Final Published Version
• Copyright Statement: © Copyright 2019 Texakalidis et al.
• License: Creative Commons Attribution 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.7759/cureus.4517
• Title of Journal or Parent Work: Cureus
• ISSN: 2168-8184
• Volume: 11
• Issue: 4
• Start Page: e4517
• End Page: e4517
• Grant/Funding Information: All authors have declared that no financial support was received from any organization for the submitted work.
• Keywords: ulnar nerve; elbow flexion; median nerve; musculocutaneous; oberlin
• Research Categories: Health Sciences, Medicine and Surgery; Biology, Neuroscience

Abstract

Background: Restriction of elbow flexion significantly limits upper extremity function following brachial plexus injuries. In recent years, the double fascicular nerve transfer procedure utilizing ulnar and median nerve transfer to musculocutaneous branches has shown promising functional outcomes. Objective: To evaluate restoration of elbow flexion following a double fascicular transfer in patients with brachial plexus injuries and identify predictors of poor outcomes. Methods: This retrospective review included 10 consecutive patients with brachial plexus injuries involving C5-C6 root avulsions who underwent the double nerve transfer procedure. The mean follow-up was 12 months and the primary outcome was assessment of elbow flexion with the use of the Medical Research Council (MRC) scale. Results: This procedure achieved elbow flexion of MRC grade M3 or higher in 50% of our cohort. Time interval from injury to surgery showed a statistically significant inverse association with functional recovery (r = -0.73, p = 0.016). Patients who had the surgery within six months of the injury, demonstrated higher MRC grades during the follow-up (p = 0.048). There was no association between elbow flexion recovery and age, body mass index (BMI), gender, hypertension, diabetes or smoking status. Conclusions: The double fascicular transfer to musculocutaneous may be a safe and effective treatment for restoration of elbow flexion. The procedure is associated with superior functional outcomes when performed within the first six months from the injury.