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Double nerve transfer for elbow flexion in obstetric brachial plexus injury: a case report

Emmanuel P Estrella1, Pierre M Mella

  • 1Microsurgery Unit, Department of Orthopedics, UP-College of Medicine, Philippine General Hospital, University of the Philippines-Manila, Taft Avenue, 1000 Manila, Philippines. estee96@yahoo.com

Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS
|August 8, 2012
PubMed

Insights

Double nerve transfers effectively restored elbow flexion and shoulder abduction in a 10-month-old with obstetric brachial plexus injury. Further surgery may be needed for shoulder external rotation.

Area of Science:

  • Pediatric Surgery
  • Neurology
  • Orthopedic Surgery

Background:

  • Obstetric brachial plexus injury (OBPI) can cause significant upper limb dysfunction.
  • Restoring shoulder abduction and elbow flexion is critical for functional recovery.

Observation:

  • A 10-month-old boy with a left extended upper type (C5-C7) OBPI underwent surgical nerve transfers.
  • Procedures included double nerve transfer (partial ulnar and median nerves) for elbow flexion and spinal accessory nerve transfer to the suprascapular nerve for shoulder abduction.

Findings:

  • At 60 months post-surgery, shoulder abduction improved to 0-150° (M4) and elbow flexion to 0-140° (M5).
  • Elbow, wrist, and finger extension achieved M5 strength.
  • Shoulder external rotation remained limited (0-30°), while finger and wrist flexion were unaffected.

Implications:

  • Double nerve transfers are a safe and effective option for restoring elbow flexion in OBPI.
  • While functional recovery is promising, secondary procedures might be necessary to enhance shoulder external rotation.

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