Posts Tagged ‘nerve transfer’
Free Editor Choice with CME: Single or Double Nerve Transfer
Background: The recovery of elbow flexion in upper brachial plexus injury can be achieved by the reinnervation of the biceps muscle (single reinnervation), but concomitant restoration of brachialis and biceps function (double reinnervation) has been recommended to improve elbow flexion strength.
Objective: To prospectively compare morbidity and outcomes of single or double muscle reinnervation in restoring elbow flexion following incomplete injury to the brachial plexus.
Methods: Forty consecutive patients were prospectively submitted to single or double muscle reinnervation. Elbow flexion strength was evaluated with a push-and-pull dynamometer 12 months after surgery. Hand morbidity related to the procedures was evaluated by the Semmes-Weinstein monofilaments test, quantification of static 2-point discrimination, and measurements of handgrip and lateral pinch strength in serial evaluations up to the final follow-up.
Ahead of Print: Upper Brachial Plexus Injuries
Background: Nerve transfers or graft repairs in upper brachial plexus palsies are two available options for elbow flexion recovery.
Objective: To assess outcomes of biceps muscle strength when treated either by grafts or nerve transfer.
Methods: A standard supraclavicular approach was performed in all patients. When roots were available, grafts were employed directed to proximal targets. Otherwise, a distal ulnar nerve fascicle was transferred to the biceps branch. Elbow flexion strength was measured with a dynamometer, and an index comparing the healthy arm and the operated-upon side was developed. Statistical analysis to compare both techniques was performed.
Editor Choice: Nerve Transfer/Repair in Brachial Plexus Injury
Nerve reconstruction for upper brachial plexus injury consists of nerve repair and/or transfer. Current literature lacks evidence supporting a preferred surgical treatment for adults with such injury involving shoulder and elbow function. We systematically reviewed the literature published from January 1990 to February 2011 using multiple databases to search the following: brachial plexus and graft, repair, reconstruction, nerve transfer, neurotization. Of 1360 articles initially identified, 33 were included in analysis, with 23 nerve transfer (399 patients), 6 nerve repair (99 patients), and 4 nerve transfer + proximal repair (117 patients) citations (mean preoperative interval, 6 ± 1.9 months). For shoulder abduction, no significant difference was found in the rates ratio (comparative probabilities of event occurrence) among the 3 methods to achieve a Medical Research Council (MRC) scale score of 3 or higher or a score of 4 or higher. For elbow flexion, the rates ratio for nerve transfer vs nerve repair to achieve an MRC scale score of 3 was 1.46 (P = .03); for nerve transfer vs nerve transfer + proximal repair to achieve an MRC scale score of 3 was 1.45 (P = .02) and an MRC scale score of 4 was 1.47 (P = .05). Read the rest of this entry »
Ahead of Print: Reconstruction of Hand Sensation
Background: In complete brachial plexus palsy, we have hypothesized that grafting to the musculocutaneous nerve should restore some hand sensation, because the musculocutaneous nerve can drive hand sensation directly or via communication with the radial and median nerves.
Objective: To investigate sensory recovery in the hand and forearm following C5 root grafting to the musculocutaneous nerve in patients with a total brachial plexus injury.
Methods: Eleven patients who had recovered elbow flexion following musculocutaneous nerve grafting from a preserved C5 root, and who had been followed-up for a minimum of three years were screened for sensory recovery in the hand and forearm. Six matched patients who had not undergone surgery served as controls. Methods of assessment included testing for pain sensation using Adson forceps, cutaneous pressure threshold measurements using Semmes-Weinstein monofilaments, and the static two-point discrimination test. Deep sensation was evaluated by squeezing the first web space, and thermal sensation was assessed using warm and cold water.
Ahead of Print: Spinal Nerve Origins of Radial Nerve Muscular Branches
Background: In injuries of the lower brachial plexus, finger flexion can be restored by nerve or tendon transfer. However, there is no technique that can guarantee good recovery of finger and thumb extension.
Objective: To determine the spinal nerve origins of the muscular branches of the radial nerve and identify potential intraplexus donor nerves for neurotization of the posterior interosseous nerve in patients with lower brachial plexus injuries.
Methods: An intraoperative electrophysiological study was carried out during 16 contralateral C7 nerve transfers. The CMAP (compound muscle action potential) of each muscle innervated by the radial nerve was recorded while the C5-T1 nerves were individually stimulated.
