Ahead of Print: Ulnar to Triceps Nerve Transfer
Background and Importance: A novel nerve transfer of a healthy motor fascicle from the ulnar nerve to the nerve of the long head of the triceps is presented, aiming to restore the elbow extension function in brachial plexus injuries involving the upper and middle trunks. A novel nerve transfer of a healthy motor fascicle from the ulnar nerve to the nerve of the long head of the triceps is presented, aiming to restore the elbow extension function in brachial plexus injuries involving the upper and middle trunks.
Clinical Presentation: Case one is a 32-year-old man sustaining a right brachial extended upper plexus injury following a motorcycle accident five months prior to admission. The CT-myelogram demonstrated avulsion of the C5 and C6 roots. Case two is a 24-year-old man who sustained a C5 to C7 injury to the left brachial plexus in a traffic accident that had occurred four months before admission. CT-myelogram demonstrated signs of C6 and C7 root avulsion. The technique included an incision at the medial border of the biceps, in the proximal third of the involved arm, followed by identification of the ulnar nerve, the radial nerve and the branch to the long head of the triceps. The proximal stump of a motor fascicle from the ulnar nerve was sutured directly to the distal stump of the nerve of the long head of the triceps. Techniques to restore elbow flexion and shoulder abduction were applied in both cases. Triceps strength MRC M4 grade was obtained in both cases.
Conclusion: The attempted nerve transfer was effective for restoration of elbow extension in primary brachial plexus surgery; however, it should only be selected for cases in which other reliable donor nerves were employed for the restoration of the elbow flexion.
From: Transfer of a Motor Fascicle from the Ulnar Nerve to the Branch of the Radial Nerve Destined to the Long Head of the Triceps for Restoration of Elbow Extension in Brachial Plexus Surgery: Technical Case Report by Flores et al