Median nerve to biceps nerve transfer to restore elbow flexion in obstetric brachial plexus palsy

Area of Science:

• Pediatric Surgery
• Neurology
• Orthopedics

Background:

• Median nerve to biceps nerve transfer is a documented procedure primarily in adult patients.
• Obstetric brachial plexus palsy (OBPP) often results in significant upper extremity functional deficits, including poor elbow flexion.
• Late presentation of OBPP cases with inadequate recovery necessitates exploration of alternative surgical interventions.

Purpose of the Study:

• To evaluate the efficacy of median nerve to biceps nerve transfer in pediatric patients diagnosed with obstetric brachial plexus palsy.
• To assess the functional recovery of elbow flexion following this nerve transfer in infants presenting with upper palsy.

Main Methods:

• A retrospective case series involving 10 infants with obstetric brachial plexus palsy (ERb's or extended ERb's palsy).
• Patients presented late, between 13-19 months of age, with limited or absent elbow flexion.
• Median nerve to biceps nerve transfer was performed, and outcomes were assessed using the Toronto scale for elbow flexion.

Main Results:

• Nine out of ten children achieved recovery of elbow flexion post-surgery.
• Functional recovery scores ranged from 6 to 7 on the Toronto scale in the successful cases.
• One child did not experience recovery of elbow flexion after the nerve transfer.

Conclusions:

• Median nerve to biceps nerve transfer is a viable and effective surgical option for improving elbow flexion in children with obstetric brachial plexus palsy.
• The procedure demonstrates significant potential for functional restoration in cases of late presentation and poor spontaneous recovery.
• This technique offers a valuable therapeutic avenue for pediatric patients suffering from specific types of brachial plexus injuries.