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A Systematic Review of Nerve Transfer and Nerve Repair for the Treatment of Adult Upper Brachial Plexus Injury

Yang, Lynda J.-S. MD, PhD*; Chang, Kate W.-C. BS, MA*; Chung, Kevin C. MD, MS

Neurosurgery:
doi: 10.1227/NEU.0b013e318257be98
Review: Editor's Choice
Editor's Choice
Abstract

Nerve reconstruction for upper brachial plexus injury consists of nerve repair and/or transfer. Current literature lacks evidence supporting a preferred surgical treatment for adults with such injury involving shoulder and elbow function. We systematically reviewed the literature published from January 1990 to February 2011 using multiple databases to search the following: brachial plexus and graft, repair, reconstruction, nerve transfer, neurotization. Of 1360 articles initially identified, 33 were included in analysis, with 23 nerve transfer (399 patients), 6 nerve repair (99 patients), and 4 nerve transfer + proximal repair (117 patients) citations (mean preoperative interval, 6 ± 1.9 months). For shoulder abduction, no significant difference was found in the rates ratio (comparative probabilities of event occurrence) among the 3 methods to achieve a Medical Research Council (MRC) scale score of 3 or higher or a score of 4 or higher. For elbow flexion, the rates ratio for nerve transfer vs nerve repair to achieve an MRC scale score of 3 was 1.46 (P = .03); for nerve transfer vs nerve transfer + proximal repair to achieve an MRC scale score of 3 was 1.45 (P = .02) and an MRC scale score of 4 was 1.47 (P = .05). Therefore, for elbow flexion recovery, nerve transfer is somewhat more effective than nerve repair; however, no particular reconstruction strategy was found to be superior to recover shoulder abduction. When considering nerve reconstruction strategies, our findings do not support the sole use of nerve transfer in upper brachial plexus injury without operative exploration to provide a clear understanding of the pathoanatomy. Supraclavicular brachial plexus exploration plays an important role in developing individual surgical strategies, and nerve repair (when donor stumps are available) should remain the standard for treatment of upper brachial plexus injury except in isolated cases solely lacking elbow flexion.

ABBREVIATION: MRC, Medical Research Council

Author Information

*Department of Neurosurgery and

Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan

Correspondence: Lynda J.-S. Yang, MD, PhD, Department of Neurosurgery, University of Michigan Health System, 1500 East Medical Center Drive, 3552 Taubman Center, Ann Arbor, MI, 48109-5338. E-mail: ljsyang@med.umich.edu

Received June 23, 2011

Accepted March 13, 2012

Copyright © by the Congress of Neurological Surgeons