After an upper brachial plexus injury (BPI), a surgeon typically performs reconstructive surgery to restore nerve supply for elbow flexion.

While there are multiple techniques to achieve this, there are no recent studies that analyze which is optimal for patients to regain elbow flexion. Researchers from Hospital for Special Surgery set out to determine the best method to improve elbow flexion strength after BPI.

The study looked at data from 12 patients who underwent a nerve transfer for elbow flexion reconstruction after a BPI. The data was collected between 2005 and 2013 and includes physical examination and electromyographic (EMG) data.  There were no demographic differences between the patients.

The researchers found that the ulnar fascicular nerve transfer to brachialis and median fascicular nerve transfer to biceps brachii motor branch appeared to have more advantages when compared to an ulnar fascicular nerve transfer to biceps brachii and median fascicular nerve transfer to brachialis motor branch. After this method, patients saw a British Medical Research Score (BMRC) grade 4 elbow flexion strength earlier than expected, as well as increased motor unit recruitment of the brachialis muscle EMG. Elbow flexion strength did eventually equalize at 36 months regardless of surgical technique.

With a lack of available literature on this specialized injury, this study provides valuable insight to surgeons who had no prior indication of the most optimal nerve transfer for their patients.

Abstract Title: Elbow Flexion Restoration in Brachial Plexus Injuries: What is the Optimal Nerve Transfer?

Authors: Natalia Fullerton, MD; Eliana Saltzman, MD; Joseph T. Nguyen, MPH; Anum Lalani, MPH; Steve K. Lee, MD; Scott W. Wolfe, MD