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Upper Brachial Plexus Injuries: Grafts vs Ulnar Fascicle Transfer to Restore Biceps Muscle Function

Socolovsky, Mariano MD, PhD*; Martins, Roberto S. MD, PhD; Di Masi, Gilda MD*; Siqueira, Mario MD, PhD

Neurosurgery:
doi: 10.1227/NEU.0b013e3182684b51
Operative Technique
Abstract

BACKGROUND: Nerve transfers or graft repairs in upper brachial plexus palsies are 2 available options for elbow flexion recovery.

OBJECTIVE: To assess outcomes of biceps muscle strength when treated either by grafts or nerve transfer.

METHODS: A standard supraclavicular approach was performed in all patients. When roots were available, grafts were used directed to proximal targets. Otherwise, a distal ulnar nerve fascicle was transferred to the biceps branch. Elbow flexion strength was measured with a dynamometer, and an index comparing the healthy arm and the operated-on side was developed. Statistical analysis to compare both techniques was performed.

RESULTS: Thirty-five patients (34 men) were included in this series. Mean age was 28.7 years (standard deviation, 8.7). Twenty-two patients (62.8%) presented with a C5-C6 injury, whereas 13 patients (37.2%) had a C5-C6-C7 lesion. Seventeen patients received reconstruction with grafts, and 18 patients were treated with a nerve transfer from the ulnar nerve to the biceps. The trauma to surgery interval (mean, 7.6 months in both groups), strength in the healthy arm, and follow-up duration were not statistically different. On the British Medical Research Council muscle strength scale, 8 of 17 (47%) patients with a graft achieved ≥ M3 biceps flexion postoperatively, vs 16 of 18 (88%) post nerve transfers (P = .024). This difference persisted when a muscle strength index assessing improvement relative to the healthy limb was used (P = .031).

CONCLUSION: The results obtained from ulnar nerve fascicle transfer to the biceps branch were superior to those achieved through reconstruction with grafts.

ABBREVIATION: BMRC, British Medical Research Council

Author Information

*Nerve & Plexus Surgery Program, Division of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina

Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil

Correspondence: Mariano Socolovsky, MD, PhD, La Pampa 1175 Torre 2 5A, Buenos Aires 1428, Argentina. E-mail: Socolovsky@fibertel.com.ar

Received December 29, 2011

Accepted June 20, 2012

Copyright © by the Congress of Neurological Surgeons