Article

Motor nerve transfers to restore extrinsic median nerve function: case report.

Department of Surgery, Division of Plastic and Reconstructive Surgery, School of Medicine, Washington University, 660 S Euclid, Campus Box 8238, Saint Louis, MO 63110, USA.
Hand 10/2008; 4(1):92-7. DOI: 10.1007/s11552-008-9128-9
Source: PubMed

ABSTRACT Active pronation is important for many activities of daily living. Loss of median nerve function including pronation is a rare sequela of humerus fracture. Tendon transfers to restore pronation are reserved for the obstetrical brachial plexus palsy patient. Transfer of expendable motor nerves is a treatment modality that can be used to restore active pronation. Nerve transfers are advantageous in that they do not require prolonged immobilization postoperatively, avoid operating within the zone of injury, reinnervate muscles in their native location prior to degeneration of the motor end plates, and result in minimal donor deficit. We report a case of lost median nerve function after a humerus fracture. Pronation was restored with transfer of the extensor carpi radialis brevis branch of the radial nerve to the pronator teres branch of the median nerve. Anterior interosseous nerve function was restored with transfer of the supinator branch to the anterior interosseous nerve. Clinically evident motor function was seen at 4 months postoperatively and continued to improve for the following 18 months. The patient has 4+/5 pronator teres, 4+/5 flexor pollicis longus, and 4-/5 index finger flexor digitorum profundus function. The transfer of the extensor carpi radialis brevis branch of the radial nerve to the pronator teres and supinator branch of the radial nerve to the anterior interosseous nerve is a novel, previously unreported method to restore extrinsic median nerve function.

0 Bookmarks
 · 
139 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We present an anatomical and histomorphometric study of the transfer of the motor branch to the brachioradialis muscle to the anterior interosseous nerve in recent brachial plexus lesions, involving C8 and T1 roots. The aim of this study was to demonstrate the anatomic constancy of the nerves involved in the transfer, feasibility, and reproducibility of the transfer. We performed a study of 14 elbows in fresh cadavers. Transfer of the motor branch of the brachioradialis muscle to the anterior interosseous nerve was possible in all specimens; there was constancy in the origin and entry into the muscle of the donor nerve, and it was always possible to dissect the recipient nerve at the level of the donor nerve, thereby allowing for direct coaptation of the nerves. The mean diameter of the anterior interosseous nerve was 2.9 ± 0.5 mm and the mean diameter of the brachioradialis muscle branch was 2 ± 0.4 mm. The branch to the brachioradialis muscle contains an average of 550 ± 64 myelinated axons and the anterior interosseous nerve has an average of 2266 ± 274 myelinated axons. The anatomic study in cadavers showed that the technique is justified and anatomically reproducible. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.
    Microsurgery 12/2012; · 1.62 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Peripheral nerve injuries are devastating injuries and can result in physical impairments, poor functional outcomes and high levels of disability. Advances in our understanding of peripheral nerve regeneration and nerve topography have lead to the development of nerve transfers to restore function. Over the past two decades, nerve transfers have been performed and modified. With the advancements in surgical management and recognition of importance of cortical plasticity, motor-reeducation and perioperative rehabilitation, nerve transfers are producing improved functional outcomes in patients with nerve injuries. This manuscript explores the recent literature as it relates to current nerve transfer techniques and advances in post-operative rehabilitation protocols, with a focus on indications, techniques and outcomes.
    Journal of Hand Therapy 01/2013; · 1.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This article provides an update of the current state of motor and sensory nerve transfers for the functional reconstruction of proximal and distal nerve lesions of the upper extremity. General principles, indications, surgical options, and functional outcomes are summarized for conventional transfers used in brachial plexus reconstruction, more recently described distal nerve transfers for isolated nerve injuries in the extremity, and sensory nerve transfers performed both proximally and distally.
    Clinics in Plastic Surgery 07/2014; · 1.35 Impact Factor

Preview

Download
1 Download
Available from