The median nerve consistently drives flexion of the distal phalanx of the ring and little fingers: Interest in finger flexion reconstruction by nerve transfers

Bertelli, Jayme Augusto; Ghizoni, Marcos Flávio; Tacca, Cristiano Paulo

doi:10.1002/micr.22333

Cited by 8 publications

(6 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Possibly this occurred because of intermuscular nerve connections between the ulnar nerve and AIN branches and because of flexor digitorum profundus tendinous interconnections. 8 After harvesting the branch of the radial nerve to the ECRB for transfer, wrist extension, not associated with radial deviation, was preserved in all our patients. This possibly results from preservation or reinnervation of the extensor carpi ulnaris following transfer of the nerve to supinator to the posterior interosseous nerve.…”

Section: Discussion Restoration Of Finger Flexionmentioning

confidence: 65%

Nerve transfers for restoration of finger flexion in patients with tetraplegia

Bertelli

Ghizoni

2017

SPI

View full text Add to dashboard Cite

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.

show abstract

Section: Discussion Restoration Of Finger Flexionmentioning

confidence: 65%

Nerve transfers for restoration of finger flexion in patients with tetraplegia

Bertelli

Ghizoni

2017

SPI

View full text Add to dashboard Cite

show abstract

“…This constitutes evidence of dual innervation of the FDP. 13 Despite good thumb and finger flexion recovery, patients could not flex their thumb without flexing other fingers. It is possible, however, that with longer follow-up and training, independent thumb and finger flexion would be possible.…”

Section: Discussionmentioning

confidence: 99%

Transfer of the Radial Nerve Branch to the Extensor Carpi Radialis Brevis to the Anterior Interosseous Nerve to Reconstruct Thumb and Finger Flexion

Bertelli

2015

The Journal of Hand Surgery

Self Cite

View full text Add to dashboard Cite

“…4 We speculated that this phenomenon was due to the cross innervation of FDP by both the median and ulnar nerve. 16 For patients who could not flex the distal interphalangeal joint of the ring and little finger, we plan to transfer the FDP tendon of the ring and little finger to those of the index and middle finger with an end-to-side suture. In a future study, whether the FDP branch of ulnar nerve could be reinnervated by nerve transfer at the first stage needed to be explored.…”

Section: Discussionmentioning

confidence: 99%

Combined Nerve and Tendon Transfers for C7-T1 Brachial Plexus Avulsion Injury

Tong

Dong

et al. 2022

Neurosurgery

View full text Add to dashboard Cite

BACKGROUND:In patients with C7-T1 brachial plexus avulsions, complete loss of hand function is commonly seen. However, the reconstruction of hand function is difficult. OBJECTIVE: To report the outcomes of hand function recovery after combined nerve and tendon transfers in C7-T1 brachial plexus injury. METHODS: From 2012 to 2019, 8 patients with C7-T1 brachial plexus injury underwent combined nerve and tendon transfers for hand function restoration, which included the following: (1) the pronator teres motor branch to the anterior interosseous nerve and brachialis motor branch to the flexor digitorum superficialis branch for finger flexion, (2) the supinator motor branch to the posterior interosseous nerve for finger extension, (3) the brachioradialis tendon transfer for thumb opposition, and (4) the radial branch of the superficial radial nerve to the sensory branch of the ulnar nerve for sensory reconstruction. Patients were evaluated for functional improvement of finger flexion, finger extension, thumb opposition, and sensory recovery. RESULTS: No clinical donor deficits were observed. Seven of eight patients recovered finger and thumb flexion (4 patients scored British Medical Research Council grade M4 and 3 scored M3). The average grip strength was 3.4 kg. All patients regained finger extension (4 scored M4 and 4 scored M3), thumb opposition, and protective sensation on the ulnar hand. Patients were able to use their reconstructed hands in daily lives. CONCLUSION: Combined nerve and tendon transfers are reliable and effective. This strategy could be an option for hand function reconstruction after C7-T1 brachial plexus injury.

show abstract

The median nerve consistently drives flexion of the distal phalanx of the ring and little fingers: Interest in finger flexion reconstruction by nerve transfers

Cited by 8 publications

References 31 publications

Nerve transfers for restoration of finger flexion in patients with tetraplegia

Nerve transfers for restoration of finger flexion in patients with tetraplegia

Transfer of the Radial Nerve Branch to the Extensor Carpi Radialis Brevis to the Anterior Interosseous Nerve to Reconstruct Thumb and Finger Flexion

Combined Nerve and Tendon Transfers for C7-T1 Brachial Plexus Avulsion Injury

Contact Info

Product

Resources

About