Results of nerve grafting in radial nerve injuries occurring proximal to the humerus, including those within the posterior cord

Bertelli, Jayme Augusto; Ghizoni, Marcos Flávio

doi:10.3171/2014.12.jns141944

Cited by 14 publications

(6 citation statements)

References 37 publications

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“…In both situations, the results of grafting have been disappointing. 2,22,27 The limitations of our study are related to the small number of patients we operated on and the patients being evaluated by the same surgeon who performed the surgery.…”

Section: Discussionmentioning

confidence: 99%

Distal pronator teres motor branch transfer for wrist extension restoration in radial nerve paralysis

Bertelli

Nehete

Duarte

et al. 2021

Journal of Neurosurgery

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OBJECTIVEThe authors describe the anatomy of the motor branches of the pronator teres (PT) as it relates to transferring the nerve of the extensor carpi radialis brevis (ECRB) to restore wrist extension in patients with radial nerve paralysis. They describe their anatomical cadaveric findings and report the results of their nerve transfer technique in several patients followed for at least 24 months postoperatively.METHODSThe authors dissected both upper limbs of 16 fresh cadavers. In 6 patients undergoing nerve surgery on the elbow, they dissected the branches of the median nerve and confirmed their identity by electrical stimulation. Of these 6 patients, 5 had had a radial nerve injury lasting 7–12 months, underwent transfer of the distal PT motor branch to the ECRB, and were followed for at least 24 months.RESULTSThe PT was innervated by two branches: a proximal branch, arising at a distance between 0 and 40 mm distal to the medial epicondyle, responsible for PT superficial head innervation, and a distal motor branch, emerging from the anterior side of the median nerve at a distance between 25 and 60 mm distal to the medial epicondyle. The distal motor branch of the PT traveled approximately 30 mm along the anterior side of the median nerve; just before the median nerve passed between the PT heads, it bifurcated to innervate the deep head and distal part of the superficial head of the PT. In 30% of the cadaver limbs, the proximal and distal PT branches converged into a single trunk distal to the medial epicondyle, while they converged into a single branch proximal to it in 70% of the limbs. The proximal and distal motor branches of the PT and the nerve to the ECRB had an average of 646, 599, and 457 myelinated fibers, respectively.All patients recovered full range of wrist flexion-extension, grade M4 strength on the British Medical Research Council scale. Grasp strength recovery achieved almost 50% of the strength of the contralateral side. All patients could maintain their wrist in extension while performing grasp measurements.CONCLUSIONSThe distal PT motor branch is suitable for reinnervation of the ECRB in radial nerve paralysis, for as long as 7–12 months postinjury.

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Section: Discussionmentioning

confidence: 99%

Distal pronator teres motor branch transfer for wrist extension restoration in radial nerve paralysis

Bertelli

Nehete

Duarte

et al. 2021

Journal of Neurosurgery

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“…Radial or posterior cord lesion. Nerve grafting in radial nerve lesions occurring proximal to the humerus or at the posterior cord usually lead to poor outcomes of wrist extension recovery in 50% of patients (Bertelli and Ghizoni, 2016b). In such lesions, distal nerve transfer constitutes an important alternative for reconstruction of wrist extension.…”

Section: Wrist Extensionmentioning

confidence: 99%

Distal nerve transfers for peripheral nerve injuries: indications and outcomes

Bertelli,

Tuffaha,

Sporer

et al. 2024

J Hand Surg Eur Vol

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Distal nerve transfer is a refined surgical technique involving the redirection of healthy sacrificable nerves from one part of the body to reinstate function in another area afflicted by paralysis or injury. This approach is particularly valuable when the original nerves are extensively damaged and standard repair methods, such as direct suturing or grafting, may be insufficient. As the nerve coaptation is close to the recipient muscles or skin, distal nerve transfers reduce the time to reinnervation. The harvesting of nerves for transfer should usually result in minimal or no donor morbidity, as any anticipated loss of function is compensated for by adjacent muscles or overlapping cutaneous territory. Recent years have witnessed notable progress in nerve transfer procedures, markedly enhancing the outcomes of upper limb reconstruction for conditions encompassing peripheral nerve, brachial plexus and spinal cord injuries.

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“…This usually follows an ‘in group’ fascicular grafting technique. 45,46 Recovery of radial nerve motor function may be expected if the repair is carried out within 15 months of the injury. 47,48 …”

Section: Treatmentmentioning

confidence: 99%

Radial nerve palsy

Bumbaširević

Palibrk²,

Lešić

et al. 2016

EFORT Open Reviews

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As a result of its proximity to the humeral shaft, as well as its long and tortuous course, the radial nerve is the most frequently injured major nerve in the upper limb, with its close proximity to the bone making it vulnerable when fractures occur.Injury is most frequently sustained during humeral fracture and gunshot injuries, but iatrogenic injuries are not unusual following surgical treatment of various other pathologies.Treatment is usually non-operative, but surgery is sometimes necessary, using a variety of often imaginative procedures. Because radial nerve injuries are the least debilitating of the upper limb nerve injuries, results are usually satisfactory.Conservative treatment certainly has a role, and one of the most important aspects of this treatment is to maintain a full passive range of motion in all the affected joints.Surgical treatment is indicated in cases when nerve transection is obvious, as in open injuries or when there is no clinical improvement after a period of conservative treatment. Different techniques are used including direct suture or nerve grafting, vascularised nerve grafts, direct nerve transfer, tendon transfer, functional muscle transfer or the promising, newer treatment of biological therapy.Cite this article: Bumbasirevic M, Palibrk T, Lesic A, Atkinson HDE. Radial nerve palsy. EFORT Open Rev 2016;1:286-294. DOI: 10.1302/2058-5241.1.000028.

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Results of nerve grafting in radial nerve injuries occurring proximal to the humerus, including those within the posterior cord

Cited by 14 publications

References 37 publications

Distal pronator teres motor branch transfer for wrist extension restoration in radial nerve paralysis

Distal pronator teres motor branch transfer for wrist extension restoration in radial nerve paralysis

Distal nerve transfers for peripheral nerve injuries: indications and outcomes

Radial nerve palsy

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