An analysis of the results of transferring the musculocutaneous nerve onto the median nerve in tetraplegics

Krasuski, Marek; Kiwerski, J

doi:10.1007/bf00390190

Cited by 28 publications

(13 citation statements)

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“…4,21 Fox et al 12 have also observed the absence of M4 finger flexion strength recovery following transfer of the nerve to the brachialis to median nerve motor fascicles in the arm. In contrast, Krasuski and Kiwerski 19 observed M4 finger flexion strength recovery in 16 of 42 tetraplegic patients in whom the branch to the brachialis and the lateral antebrachial cutaneous nerve were transferred to the median nerve. After a minimum follow-up of 24 months, they observed that good results were clearly associated with age of less than 25 years and surgery within 3 months after accident.…”

Section: Discussion Restoration Of Finger Flexionmentioning

confidence: 90%

Nerve transfers for restoration of finger flexion in patients with tetraplegia

Bertelli

Ghizoni

2017

SPI

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OBJECTIVE The purpose of this paper was to report the authors' results with finger flexion restoration by nerve transfer in patients with tetraplegia. METHODS Surgery was performed for restoration of finger flexion in 17 upper limbs of 9 patients (8 male and 1 female) at a mean of 7.6 months (SD 4 months) after cervical spinal cord injury. The patients' mean age at the time of surgery was 28 years (SD 15 years). The motor level according to the ASIA (American Spinal Injury Association) classification was C-5 in 4 upper limbs, C-6 in 10, and C-7 in 3. In 3 upper limbs, the nerve to the brachialis was transferred to the anterior interosseous nerve (AIN), which was separated from the median nerve from the antecubital fossa to the midarm. In 5 upper limbs, the nerve to the brachialis was transferred to median nerve motor fascicles innervating finger flexion muscles in the midarm. In 4 upper limbs, the nerve to the brachioradialis was transferred to the AIN. In the remaining 5 upper limbs, the nerve to the extensor carpi radialis brevis (ECRB) was transferred to the AIN. Patients were followed for an average of 16 months (SD 6 months). At the final evaluation the range of finger flexion and strength were estimated by manual muscle testing according to the British Medical Research Council scale. RESULTS Restoration of finger flexion was observed in 4 of 8 upper limbs in which the nerve to the brachialis was used as a donor. The range of motion was incomplete in all 5 of these limbs, and the strength was M3 in 3 limbs and M4 in 1 limb. Proximal retrograde dissection of the AIN was associated with better outcomes than transfer of the nerve to the brachialis to median nerve motor fascicles in the arm. After the nerve to the brachioradialis was transferred to the AIN, incomplete finger flexion with M4 strength was restored in 1 limb; the remaining 3 limbs did not show any recovery. Full finger flexion with M4 strength was demonstrated in all 5 upper limbs in which the nerve to the ECRB was transferred to the AIN. No functional downgrading of elbow flexion or wrist extension strength was observed. CONCLUSIONS In patients with tetraplegia, finger flexion can be restored by nerve transfer. Nerve transfer using the nerve to the ECRB as the donor nerve produced better recovery of finger flexion in comparison with nerve transfer using the nerve to the brachialis or brachioradialis.

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Section: Discussion Restoration Of Finger Flexionmentioning

confidence: 90%

Nerve transfers for restoration of finger flexion in patients with tetraplegia

Bertelli

Ghizoni

2017

SPI

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“…Thirteen journal articles reported 89 nerve transfers in the upper limb in 59 patients with tetraplegia, including 15 cases of dual-nerve transfer [10][11][12] and 1 case of triple-nerve transfer. 13 All cases were single-case reports except the early series reported by Kiwerski and Krasuski 8,9 and the most recently published series by Bertelli. The studies are summarized in ►Table 1.…”

Section: Search Resultsmentioning

confidence: 99%

“…Krasuski and Kiwerski went on to report a total of 42 patients with C6-7 complete SCI who underwent a musculocutaneous to median nerve transfer an average of 3 to 4 months post injury. 9 Results were similarly reported on a three-point grading of simple hand function. "Good," "fair," and "bad" results were seen in 16, 16, and 10 patients, respectively.…”

Section: Summary Of Casesmentioning

confidence: 94%

“…Kiwerski reported outcomes for musculocutaneous to median nerve transfers in two reports. 8,9 The 20 patients from the first study were included again in the second. Quantitative assessments were performed primarily with descriptive data.…”

Section: Data Extraction and Statistical Analysismentioning

confidence: 99%

“…7 Kiwerski in 1982 8 reported 20 cases and later went on to report further results in 1991. 9 However, despite these early reported cases, the use of nerve transfers for the reconstruction of upper limb function in tetraplegia has received little attention until relatively recently. This review documents the current status of nerve transfer surgery for upper limb reanimation in tetraplegia, and summarizes the reported outcome of 90 transfers, including 15 case reports of double-nerve transfer and one case of triple-nerve transfer.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Review of Upper Extremity Nerve Transfer in Cervical Spinal Cord Injury

Cain

Gohritz

Fridén

et al. 2015

J Brachial Plex Peripher Nerve Inj

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Functional outcome after transfer of brachialis on anterior interosseous and supinator on posterior interosseous nerves: A preliminary report

Sacco

Olivi²,

Visani

et al. 2022

Microsurgery

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Objective Traumatic spinal cord injury (SCI) resulting in tetraplegia is a leading cause of morbidity among young adults worldwide and its management remains challenging. Restoring hand function in these patients must be considered a top priority with great impact on their quality of life (QOL); although nerve and tendon transfer have been extensively described, type of procedure to be chosen is not standardized and few studies have determined the functional outcome of those procedure and their impact on QOL is still poorly assessed. We report a preliminary retrospective study regarding feasibility and functional outcomes of nerve transfer procedures including bilateral brachialis nerve on anterior interosseous nerve (AIN) and supinator branch on posterior interosseous nerve (PIN) for hand reanimation following SCI focusing on the impact of these procedures on QOL. Methods We performed a retrospective study involving patient sustained SCI and underwent nerve transfer of brachialis branch from musculocutaneous nerve on AIN and supinator branch from the trunk of the radial nerve on the PIN. We included 11 patients (14 limbs) with traumatic SCI resulting in C4 level tetraplegia in five patients, C5 in four and C6 and C7 in one case each, with a median age of 31.5 years underwent surgery at a median of 10 months after injury; including both transfers in 10 cases and AIN reanimation only in one. Functional assessment including medical research council (MCR) grade, graded redefined assessment of strength sensation and prehension (GRASSP) and spinal cord independence measure (SCIM) were performed at least 12 months follow up. Results Thirteen PIN innervated muscles achieved an MRC score ≥3/5 whereas AIN supplied muscles in 5 out of 15. GRASSP qualitative measure improved from a baseline value of 1 to 2, while quantitative measure passed from 1 to 3 after 12 months; the difference was statistically significant (p = .005 and p = .008, respectively). SCIM self‐care sub‐score also statistically significant improved from 3 to 4 at 12 months (p = .016). No complication or donor morbidity occurred. Conclusions Functional performance has been significantly improved by nerve transfer procedures 1 year after surgery. Nerve transfers may represent a valuable option for the restoration of the hand function in patients with tetraplegia with minor or no morbidity.

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An analysis of the results of transferring the musculocutaneous nerve onto the median nerve in tetraplegics

Cited by 28 publications

References 1 publication

Nerve transfers for restoration of finger flexion in patients with tetraplegia

Nerve transfers for restoration of finger flexion in patients with tetraplegia

Review of Upper Extremity Nerve Transfer in Cervical Spinal Cord Injury

Functional outcome after transfer of brachialis on anterior interosseous and supinator on posterior interosseous nerves: A preliminary report

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