Original Communications
Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature,☆☆

https://doi.org/10.1053/jhsu.2001.21518Get rights and content

Abstract

We report the results of 15 patients who underwent nerve transfer for restoration of shoulder and elbow function at our institution for traumatic brachial plexus palsy. We present these results in the context of a meta-analysis of the English literature, designed to quantitatively assess the efficacy of individual nerve transfers for restoration of elbow and shoulder function in a large number of patients. One thousand eighty-eight nerve transfers from 27 studies met the inclusion criteria of the analysis. Seventy-two percent of direct intercostal to musculocutaneous transfers (without interposition nerve grafts) achieved biceps strength ≥M3 versus 47% using interposition grafts. Direct intercostal transfers to the musculocutaneous nerve had a better ability to achieve ≥M4 elbow strength than transfers from the spinal accessory nerve (41% vs 29%). The suprascapular nerve fared significantly better than the axillary nerve in obtaining ≥M3 shoulder abduction (92% vs 69%). At our institution 90% of intercostal to musculocutaneous transfers (n = 10) achieved ≥M3 bicep strength and 70% achieved ≥M4 strength. Four of seven patients achieved ≥M3 shoulder abduction with a single nerve transfer and 6 of 7 regained ≥M3 strength with a dual nerve transfer. This study suggests that interposition nerve grafts should be avoided when possible when performing nerve transfers. Better results for restoration of elbow flexion have been attained with intercostal to musculocutaneous transfers than with spinal accessory nerve transfers and spinal accessory to suprascapular transfers appear to have the best outcomes for return of shoulder abduction. We conclude that nerve transfer is an effective means to restore elbow and shoulder function in brachial plexus paralysis. (J Hand Surg 2001;26A:303-314. Copyright © 2001 by the American Society for Surgery of the Hand.)

Section snippets

Case series

Between October 1991 and November 1999 we performed surgical exploration and repair on 35 patients (age range, 4 months to 67 years) with brachial plexus injuries. Of these, 29 had nerve transfers. Fifteen patients with nerve transfers met the inclusion criteria for the study, which included surgery within 12 months of injury and a minimum follow-up period of 1 year. All 15 patients were male. Perinatal brachial plexus palsies were excluded from the analysis. The dominant extremity was involved

Case series

In the series of patients from our institution we achieved restoration of ≥M3 bicep strength in 9 of the 10 intercostal to musculocutaneous nerve transfers. Seven of the 10 patients achieved M4 biceps recovery. One medial pectoral nerve to musculocutaneous nerve transfer was performed that obtained M3 biceps strength (Table 3).

For restoration of shoulder abduction 3 of 6 patients who underwent spinal accessory to suprascapular nerve transfer achieved ≥M3 shoulder abduction and 2 of these

Discussion

The functional outcomes of our 15 patients who underwent nerve transfer for restoration of shoulder and elbow function mirror the results of the English literature and provide additional support for this reconstruction option in these severely injured patients. The results of the meta-analysis suggest that there is a disadvantage to using interposition nerve grafts when performing intercostal nerve transfers for restoration of biceps function. There are some theoretical advantages to

Acknowledgements

The authors thank Alain C.J. Delotbiniere, MD, for the inclusion of his patients in this series.

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    ☆☆

    Reprint requests: Scott W. Wolfe, MD, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021.

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