Nerve transfers for Reanimation of Elbow Extension
Teboul Aaron Frédéric, MD, MS; Jean-Noel Goubier, MD, PhD
Institute for Nerve and Brachial Plexus Surgery, Paris, France
Introduction: Elbow flexion is the first goal in upper partial brachial plexus palsy treatment. However, elbow extension is essential for daily living activities. In order to recover this function, the transfer of one fascicle of ulnar nerve to the branch of the long head of the triceps has been previously published in only two patients. The goal of our study is to assess the transfer of one fascicle of ulnar nerve to the branch of the long head of the triceps to recover elbow extension in a larger series.
Patient & Methods: Ten male patients with C5C6 and C7 brachial plexus injury were operated. For shoulder recovery, Spinal accessory nerve and rhomboid nerve transfer were performed. For elbow flexion, one fascicle of median nerve was transferred to the nerve of the biceps. Concerning elbow extension, the transfer of one fascicle of ulnar nerve to the branch of the long head of the triceps were performed. Tendon transfers were proposed for wrist and finger extension.
Results: Nine patients recovered M4 elbow flexion and extension. One patients had M3 elbow extension and flexion. Average active shoulder elevation was 85° and average active shoulder external rotation was 65°. All Patients recovered finger and wrist extension.
Discussion: The classical techniques of grafts or phrenic or intercostal nerve transfers for elbow extension reanimation are not always reliable according the literature. Because of harvested ulnar nerve motor fascicle is close to the branch of the long head of the triceps, the time of recovery is shorter than other described nerve transfers. The isolated recovery of the reinnervated long head of the triceps muscle excludes spontaneous recovery occasionally noted in upper root plexus injuries.
Conclusion: The transfer of one fascicle of ulnar nerve to the branch of the long head of the triceps technique is reliable for active elbow extension recovery in C5, C6 and C7 brachial plexus palsies.
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