Correlation between the elbow flexion and the hand and wrist flexion after neurotization of the fascicles of the ulnar nerve to the motor branch to the biceps

Abstract

ObjectiveGain in elbow flexion in patients with brachial plexus injury is extremely important. The transfer of a fascicle from the ulnar nerve to the motor branch of the musculocutaneous nerve (Oberlin surgery) is a treatment option. However, in some patients, gain in elbow flexion is associated with wrist and finger flexion. This study aimed to assess the frequency of this association and the functional behavior of the limb.MethodsCase–control study of 18 patients who underwent the Oberlin surgery. Group 1 included patients without disassociation of range of elbow flexion and that of the fingers and wrist; Group 2 included patients in whom this disassociation was present. In the functional evaluation, the Sollerman and DASH tests were used.ResultsIt was observed that 38.89% of the patients did not present disassociation of elbow flexion with flexion of the wrist and fingers. Despite the existence of a favorable difference in the group with disassociation of the movement, when the Sollerman protocol was applied to the comparison between both groups, this difference was not statistically significant. With the DASH test, however, there was a statistically significant difference in favor of the group of patients who managed to disassociate the movement.ConclusionThe association of elbow flexion with flexion of the wrist and fingers, in the group studied, was shown to be a frequent event, which influenced the functional result of the affected limb.

A Funhouse Mirror: Muscular Co-Contractions as a Reflection of a Spontaneous Aberrant Regeneration of the Brachial Plexus Injury in the Adults - Anatomical Background, an Attempt to Classify and Their Clinical Relevance within the Reconstruction Strategie

“…It is well known that any type of NT, especially when a donor-nerve provides motor fascicles to more than a single muscle, could potentially produce co-activation ("induced" Co-C Table 1) of other muscles related to the donor's nerve during the early stages of clinically visible regeneration [17]. Reduction of this type of co-activation is achieved through active rehabilitation programs [17]. Most of the programs are aimed at dissociating the voluntary activation of the newly obtained function from the entire area of the cortical representation of the donor nerve [17].…”

“…Reduction of this type of co-activation is achieved through active rehabilitation programs [17]. Most of the programs are aimed at dissociating the voluntary activation of the newly obtained function from the entire area of the cortical representation of the donor nerve [17]. The widespread adoption of NTs among the surgical society quickly isolated a pool of unwanted NTs.…”

“…Hence, the evaluation of the efficacy of any type of NT is generally narrowed to the identification of either a muscular power (MRC) or a change in a joint angle produced by the recovered muscle, Oberlin or double-fascicular NT have become most popular and have established themselves as a "golden standard" [2]. The induced "proximal-distal" (Table 1) Co-C, which follows the abovementioned procedures, is one of those that are easily nullified even without any extensive reeducation [17].…”

“…On the other hand, the influence of a nerve transfer on the intimate biomechanical correlation between the upper arm and hand movements is underestimated in most cases. Only a few publications have attempted to characterize and define the real meaning of this coordination and the influence of induced proximal-distal co-activation on the affected limb on a global scale [17]. Escudero et al [17] discovered that at least 39% of patients who received Oberlin transfer were unable to dissociate elbow flexion from wrist/finger flexion.…”

“…Only a few publications have attempted to characterize and define the real meaning of this coordination and the influence of induced proximal-distal co-activation on the affected limb on a global scale [17]. Escudero et al [17] discovered that at least 39% of patients who received Oberlin transfer were unable to dissociate elbow flexion from wrist/finger flexion. From a biomechanical point of view, this meant that it deeply "confounded" the function of the hand during daily activities [17].…”