Double fascicular nerve transfer for elbow flexion and extension

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Anatomy

Background:

• Traumatic brachial plexus injuries cause significant functional deficits.
• Nerve transfers offer potential for functional restoration, including elbow flexion and shoulder abduction.
• Restoring both elbow flexion and extension is critical for upper limb function.

Purpose of the Study:

• To investigate the feasibility of a double fascicular nerve transfer to restore both elbow flexion and extension in cases of combined biceps and triceps paralysis.
• To elucidate the anatomical considerations for performing this double nerve transfer via a medial approach.

Main Methods:

• Three cadaver upper limbs were used to perform nerve transfers.
• The expendable motor fascicle of the ulnar nerve was transferred to the biceps branch of the musculocutaneous nerve.
• The expendable motor fascicle of the median nerve was transferred to the triceps (ulnar collateral) branch of the radial nerve.
• Anatomical measurements and feasibility were evaluated via a medial approach.

Main Results:

• The double nerve transfer was successfully and consistently performed in all cadavers.
• Transfers were tension-free throughout the full range of motion at the elbow.
• Key anatomical landmarks and distances for the triceps branch of the radial nerve and recipient sites were identified.

Conclusions:

• A double fascicular nerve transfer from the ulnar and median nerves to the biceps and triceps branches, respectively, is anatomically feasible.
• This technique can be performed via a medial approach, offering a potential solution for restoring elbow flexion and extension after severe brachial plexus injuries.