Transfer of the Brachialis to the Anterior Interosseous Nerve as a Treatment Strategy for Cervical Spinal Cord Injury: Technical Note

Hawasli, Ammar H.; Chang, Jen Jen; Reynolds, Matthew R.; Ray, Wilson Z.

doi:10.1055/s-0034-1396760

Cited by 25 publications

(20 citation statements)

References 42 publications

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“…All patients with anterior/anteromedial FCs had denervation of the PT and/or FCR muscles observed on EDX and/or MRN. This finding is corroborated by previous reports associating the anterior/anteromedial region with motor nerve branches supplying the PT and FCR muscles . Maldonado et al documented frequent involvement of the PT and FCR muscles in clinically suspected “isolated” AIN palsy in 5 of 16 patients; in our study, 7 of 22 patients exhibited this phenomenon .…”

Section: Discussionsupporting

confidence: 93%

“…We found posteriorly/posteromedially positioned FCs in 91% of site 1 patients, for which the mean distance was 4.7 cm proximal to the elbow joint line. This corresponds with the topographical location of the AIN fascicular bundle described in cadaveric and surgical studies . In a previous MRI study that reported fascicular abnormalities of the median nerve proper in patients with AINS, increased T2‐weighted signal was found in the posterolateral position of the median nerve (as opposed to the posterior/posteromedial position), and signal was maximal in intensity 14.6 cm proximal to the medial epicondyle .…”

Section: Discussionsupporting

confidence: 84%

“…This corresponds with the topographical location of the AIN fascicular bundle described in cadaveric and surgical studies. 16,24,25 In a previous MRI study that reported fascicular abnormalities of the median nerve proper in patients with AINS, increased T2-weighted signal was found in the posterolateral position of the median nerve (as opposed to the posterior/posteromedial position), and signal was maximal in intensity 14.6 cm proximal to the medial epicondyle. 32 One possible explanation for the difference is that, in the earlier study, a single point of maximal signal intensity had to be located, and frequently segmental enlargement extends proximally from a constriction site.…”

Section: Resultsmentioning

confidence: 94%

“…Laterally positioned FCs were identified in 3 patients at site 1 (2 anterolateral, 1 posterolateral) and 1 patient at site 2 (anterolateral). The most laterally positioned fascicles reportedly supply sensation in the median nerve distribution, although sensory disturbances were not reported. As such, the fascicles involved may have been the result of either anatomic variation, or possibly of sensorimotor disturbance not clinically or electrodiagnostically appreciable.…”

Section: Discussionmentioning

confidence: 97%

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Fascicular constrictions above elbow typify anterior interosseous nerve syndrome

et al. 2019

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Introduction In this study we tested the hypothesis that fascicular constrictions (FCs) of the median nerve proximal to the elbow joint characterize anterior interosseous nerve syndrome (AINS). Methods Magnetic resonance neurography (MRN) and ultrasound (US) examinations were evaluated in 45 patients with clinically suspected AINS. All 22 patients at site 1 underwent MRN and 8 underwent US; all 23 patients at site 2 underwent US. Results Median nerve FCs were identified in all MRN cases; FCs and/or fascicular enlargements were identified in 88% of US cases. Most FCs were in the mediannerve posterior/posteromedial region and were proximal to the elbow joint line (mean distance: MRN, 5.4 cm; US, 7.5 cm), with the exception of a single FC (located 1 cm distal). No extrinsic compression of median or anterior interosseous nerves was identified in the arm or forearm. Discussion AINS is a noncompressive neuropathy characterized by median nerve FCs in the arm.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 84%

Section: Resultsmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 97%

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Fascicular constrictions above elbow typify anterior interosseous nerve syndrome

et al. 2019

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“…The BCM branch has been transferred to the AIN fascicle in the arm to recover FPL and FDP function [147,177,178].…”

Section: Transfers For Spinal Cord Injured Patientsmentioning

confidence: 99%

Nerve Transfers in the Treatment of Peripheral Nerve Injuries

Vanaclocha‐Vanaclocha¹,

Ortiz-Criado²,

NievesSáiz-Sapena³

et al. 2017

Peripheral Nerve Regeneration - From Surgery to New Therapeutic Approaches Including Biomaterials and Cell-Based Therapies Deve

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Successful re-innervation of proximal limb peripheral nerve injuries is rare. Axons regenerate at ~1 mm/day, reaching hand muscles by 24 months, finding them atrophied and fibrosed. Peripheral nerve injury repair is often delayed waiting for spontaneous recovery. This waiting time should not be longer than 6 months as after 18 months reinnervation will not achieve effective muscular function. When spontaneous recovery is impossible, referral too late or damage too severe, other options like a transfer from a nearby healthy nerve to the injured one must be considered. They are very successful, and the deficit in the donor site is usually minimal. The most common nerve transfers are a branch of the spinal nerve to the trapezius muscle to the suprascapular nerve, a branch of the long head of the triceps to the axillary nerve, a fascicle of the ulnar nerve to the motor branch of the biceps muscle, two branches of the median nerve to the posterior interosseous nerve and the anterior interosseous nerve to the ulnar nerve. There are many more options that can suit particular cases. Introduced in brachial plexus injury repair, they are now also applied to lower limb, to stroke and to some spinal cord injuries.

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Double nerve transfer for restoration of hand grasp and release in C7 tetraplegia following complete cervical spinal cord injury

Emamhadi

Andalib

2018

Acta Neurochir

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Cervical spinal cord injury (SCI) can cause tetraplegia. Nerve transfer has been routinely utilized for reconstruction of hand in brachial plexus injuries. Here, we report reconstruction of finger flexion (hand grasp) and extension (hand release) in a victim of cervical spinal cord injury with tetraplegia. We also focus on importance of extension phase in restoration of hand function in the tetraplegic case, in addition to provision of a detailed description of both operations including text, photographs, and a video. We used double nerve transfer, namely brachialis branches of musculocutaneous nerve to anterior interosseous nerve (AIN) and supinator branch of radial nerve to posterior interosseous nerve (PIN). We found that brachialis nerve transfer to AIN (for finger flexion) and supinator branch nerve transfer to PIN (for finger extension) can provide finger flexion and extension simultaneously. Brachialis nerve transfer to AIN and supinator branch nerve transfer to PIN may be an acceptable surgical technique to restore hand grasp and release in tetraplegia after SCI.

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Transfer of the Brachialis to the Anterior Interosseous Nerve as a Treatment Strategy for Cervical Spinal Cord Injury: Technical Note

Cited by 25 publications

References 42 publications

Fascicular constrictions above elbow typify anterior interosseous nerve syndrome

Fascicular constrictions above elbow typify anterior interosseous nerve syndrome

Nerve Transfers in the Treatment of Peripheral Nerve Injuries

Double nerve transfer for restoration of hand grasp and release in C7 tetraplegia following complete cervical spinal cord injury

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