Transfer of the Distal Anterior Interosseous Nerve for Thumb Motion Reconstruction in Radial Nerve Paralysis

Bertelli, Jayme Augusto; Nehete, Sushil; Duarte, Elisa Cristiana Winkelmann; Ghizoni, Marcos Flávio

doi:10.1016/j.jhsa.2020.02.011

Cited by 15 publications

(13 citation statements)

References 35 publications

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“…The DPIN innervates the deep muscles layer: abductor pollicis longus, extensor pollicis longus and brevis and extensor index proprius. The deep branch terminates as the sensory branch at the floor of the 4 h extensor compartment (Bertelli et al, 2009; Bertelli et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Selective transfer of nerve to supinator to restore digital extension in central cord syndrome: An anatomical study and a case report

et al. 2022

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Background Nerve transfers are increasingly used to restore upper extremity function in patients with spinal cord injury. However, the role of nerve transfers for central cord syndrome is still being established. The purpose of this study is to report the anatomical feasibility and clinical use of nerve transfer of supinator motor branches (NS) to restore finger extension in a central cord syndrome patient. Materials and Methods The posterior interosseous nerve (PIN), its superficial division, and branches were dissected in 14 fresh cadavers, with a mean age of 65 (58–79). Measurements included number and length of branches of donor and recipient, diameters, regeneration distance from coaptation site to motor entry point and axonal counts. A NS transfer to extensor carpi ulnaris (ECU), extensor digiti quinti (EDQ) and extensor digitorum communis (EDC) was performed in a 28‐year‐old patient, with central cord syndrome after a motorcycle accident, who did not recover active finger extension at 10 months post injury. Results The PIN consistently divided into a deep and superficial branch between 1.5 cm proximal to, and 2 cm distal to the distal boundary of the supinator. The superficial branch provided a first common branch to the ECU and EDQ. In 12/14 dissections, the EDC was innervated by a 4 cm long branch that entered the muscle on its radial deep surface. In all cases, the superficial branch of the PIN could be separated in a retrograde fashion from the PIN and coapted with NS. The mean myelinated fiber count in nerve to EDC was 401 ± 190 compared to 398 ± 75 in the NS. At 48 months after surgery, with the wrist at neutral, the patient recovered full metacarpophalangeal extension scoring M4. Supination was preserved with the elbow extended or flexed. Conclusions Restoration of finger extension in central cord syndrome is possible with a selective transfer of the NS to EDC, and is anatomically feasible with a short regeneration distance and favorable axonal count ratio.

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confidence: 99%

Selective transfer of nerve to supinator to restore digital extension in central cord syndrome: An anatomical study and a case report

et al. 2022

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“…The PIN branches as it goes deep to the superficial head of the supinator, giving branch(es) to the supinator, and then branching into the deep and superficial heads of the PIN ( Figure 1 ) [ 9 ]. According to Bertelli et al.…”

Section: Introductionmentioning

confidence: 99%

“…According to Bertelli et al. [ 9 ] the superficial head gives branches to extensor digitorum communis (EDC), extensor carpi ulnaris (ECU) and extensor digiti minimi (EDM), and the deep head further branches into medial and lateral branches of the PIN. The medial branch innervates extensor indicis proprius (EIP) and extensor pollicis longus (EPL), and the lateral head innervates extensor pollicis brevis (EPB) and abductor pollicis longus (APL).…”

Section: Introductionmentioning

confidence: 99%

“…However, since sacrifice of PQ leaves little clinical deficit [ 11 ], it was a valuable option in this case since its nerve branch provided enough length ( Figure 2 ) to reach the recipient branches of the injured PIN. The distal AIN has been used for transfer in more distal PIN/radial nerve dysfunction, in particular for thumb motion [ 9 ]. However, we do not know of any study using the AIN for a more proximal PIN transfer.…”

Section: Introductionmentioning

confidence: 99%

“…However, we do not know of any study using the AIN for a more proximal PIN transfer. The transfer more distally is performed to improve thumb function as often there is limited thumb extension recovery with flexorcarpi radialis (FCR) to PIN transfer [ 9 , 12 ]. While FCR is typically used for proximal PIN transfer, this transfer was not performed in our case because the zone of injury was very large and we could only innervate the PIN branches after they had already branched more distally.…”

Section: Introductionmentioning

confidence: 99%

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A Fresh Cadaver Study on the Innervation of Brachioradialis and Extensor Carpi Radialis Longus Muscles

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Transfer of the Distal Anterior Interosseous Nerve for Thumb Motion Reconstruction in Radial Nerve Paralysis

Cited by 15 publications

References 35 publications

Selective transfer of nerve to supinator to restore digital extension in central cord syndrome: An anatomical study and a case report

Selective transfer of nerve to supinator to restore digital extension in central cord syndrome: An anatomical study and a case report

AIN to PIN transfer for PIN palsy following distal biceps tendon repair: a case report

A Fresh Cadaver Study on the Innervation of Brachioradialis and Extensor Carpi Radialis Longus Muscles

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