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Elbow Flexion Reanimation

Shah, Neil V. MD, MS1; Kelly, John J. MS1,2; Patel, Aakash M. BA1,3; White, Colin M.1; Hausman, Michael R. MD4; Koehler, Steven M. MD1

doi: 10.2106/JBJS.RVW.18.00194
Review Articles

  • » Restoration of elbow flexion in the setting of brachial plexopathy is crucial and can be accomplished in a number of ways. Current options include non-free muscle transfers, including tendon, nerve, and pedicled flap transfers, and free functional muscle transfers, most frequently involving transfer of the gracilis muscle.
  • » Currently, free functional muscle transfer is employed when all other options have been exhausted. Graft-related advantages include lack of functional deficits at the donor site, similar size of vascular structures of the gracilis to the thoracoacromial artery and cephalic vein, and contractile fibers running in parallel to the muscle’s course.
  • » Evidence is limited when comparing various methods of elbow flexion reanimation, particularly when evaluating free functional muscle transfers and non-free muscle transfers against each other. However, current but limited evidence appears to demonstrate favorable functional outcomes with free functional muscle transfers, although prospective studies are needed to confirm these findings.

1Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York

2School of Medicine, SUNY Upstate Medical University, Syracuse, New York

3Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, Illinois

4Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY

E-mail address for N.V. Shah:

Investigation performed at the Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York

Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work and “yes” to indicate that the author had other relationships or activities that could be perceived to influence, or have the potential to influence, what was written in this work (

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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