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The Double Fascicular Nerve Transfer for Restoration of Elbow Flexion

Toussaint, Charles P MD*; Zager, Eric L MD†

doi: 10.1227/NEU.0b013e31820958e8
Operative Technique

BACKGROUND: Injuries to the upper trunk of the brachial plexus are debilitating, affecting primarily shoulder abduction and elbow flexion. Treatment is aimed at restoring shoulder stabilization, shoulder abduction, and elbow flexion and may be accomplished by nerve grafting, nerve transfer, or functional muscular transfer.

OBJECTIVE: To describe the double fascicular nerve transfer with the goal of restoring elbow flexion.

METHODS: The double fascicular nerve transfer involves transferring an ulnar nerve fascicle to the musculocutaneous nerve innervating the biceps muscle and a median nerve fascicle transfer to a branch of musculocutaneous nerve supplying the brachialis muscle.

RESULTS: The double fascicular nerve transfer is effective in restoring elbow flexion after severe upper-trunk brachial plexus injuries.

CONCLUSION: Advantages of this procedure are that the nerve repair is done very close to the target muscle for reinnervation, so time to reinnervation is minimized, and the surgery takes place distal to the site of injury in nontraumatized tissue.

*Department of Neurosurgery, University of South Carolina School of Medicine, Columbia, South Carolina; †Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

Received, January 25, 2010.

Accepted, August 2, 2010.

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Correspondence: Eric L. Zager, MD, Professor of Neurosurgery, Department of Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104. E-mail:

Copyright © by the Congress of Neurological Surgeons