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Comparison of Single versus Double Nerve Transfers for Elbow Flexion after Brachial Plexus Injury

Carlsen, Brian T. M.D.; Kircher, Michelle F. R.N.; Spinner, Robert J. M.D.; Bishop, Allen T. M.D.; Shin, Alexander Y. M.D.

Plastic and Reconstructive Surgery: January 2011 - Volume 127 - Issue 1 - p 269-276
doi: 10.1097/PRS.0b013e3181f95be7
Hand/Peripheral Nerve: Original Articles

Background: Restoration of elbow flexion is commonly achieved with nerve transfer to the musculocutaneous nerve branches after upper trunk brachial plexus injury. It is unknown if double nerve transfer to the biceps and brachialis nerve branches results in greater strength than single nerve transfer to the biceps branch alone.

Methods: A retrospective review was performed of all patients receiving nerve transfer to restore elbow flexion. Single and double nerve transfers were compared in regard to severity of injury, elbow flexion, supination, grip strengths, and Disabilities of the Arm, Shoulder, and Hand scores. Elbow flexion and supination torque strength were measured quantitatively.

Results: Fifty-five patients underwent nerve transfer to restore elbow flexion (23 single, 32 double). At similar follow-up periods, British Medical Research Council grade improved to 4 or better in 14 of 21 single and 24 of 30 double nerve transfer patients. Supination strength was similar between groups (p = 0.148). Grip strength was greater in the double nerve transfer patients (p = 0.028). Preoperative Disabilities of the Arm, Shoulder, and Hand scores were significantly greater in single versus double nerve transfer patients (p = 0.018). Although single nerve transfer patients had a greater improvement in scores, the final mean scores were similar in the two groups. The severity of injury was different between the two groups, with 19 of 23 single nerve transfer patients having injury beyond the C5–6 level and only 16 of 32 of double nerve transfer patients with greater than C5–6 injury (p = 0.020).

Conclusions: Outcomes are similar between the two groups for elbow flexion and supination strength. Postoperative Disabilities of the Arm, Shoulder, and Hand scores are similar in single and double nerve transfer patients.

Rochester, Minn.

From the Division of Hand Surgery, Department of Orthopedic Surgery; Division of Plastic Surgery, Department of Surgery; and Department of Neurosurgery, Mayo Clinic.

Received for publication January 26, 2010; accepted June 23, 2010.

Presented at the Federation of European Societies for Surgery of the Hand 2008 meeting, in Lausanne, Switzerland, June of 2008; the American Association for Hand Surgery 2009 meeting, in Maui, Hawaii, January of 2009; and the American Society for Surgery of the Hand 2009 meeting, in San Francisco, California, September of 2009.

Disclosure: The work for this article was not supported by any external or internal funding sources. The authors have no commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this article.

Brian T. Carlsen, M.D.; Division of Plastic Surgery; Department of Surgery; Division of Hand Surgery; Department of Orthopedic Surgery; Mayo Clinic; 200 First Street SW; Rochester, Minn. 55901;

©2011American Society of Plastic Surgeons