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Updated: Apr 26, 2026
Structured Motor Rehabilitation After Selective Nerve Transfers
Published on: August 15, 2019
Reconstruction of pediatric brachial plexus injuries with nerve grafts and nerve transfers
Harvey Chim1, Michelle F Kircher1, Robert J Spinner1
1Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN; Department of Neurosurgery, Mayo Clinic, Rochester, MN.
Insights
Nerve grafts and nerve transfers yield similar outcomes for pediatric traumatic brachial plexus injuries, specifically for shoulder abduction and elbow flexion. Contralateral C7 nerve transfer is not recommended for shoulder abduction reconstruction in this age group.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Regenerative Medicine
Background:
- Traumatic pediatric brachial plexus injuries (BPI) present complex reconstructive challenges.
- Understanding injury patterns and treatment outcomes is crucial for optimizing patient care.
- Nerve reconstruction techniques aim to restore function in shoulder abduction and elbow flexion.
Purpose of the Study:
- To analyze demographics and injury patterns in pediatric traumatic BPI.
- To evaluate outcomes of nerve grafting versus nerve transfers for shoulder abduction and elbow flexion.
- To compare functional recovery based on Medical Research Council (MRC) motor grading.
Main Methods:
- Retrospective review of 45 pediatric patients with traumatic BPI (1996-2012).
- Subgroup analysis of patients undergoing nerve grafting or nerve transfers for shoulder abduction and elbow flexion.
- Comparison of outcomes using MRC motor grading.
Main Results:
- Panplexal (62%) and upper plexus (16%) injuries were common, with a high rate of preganglionic injuries (91%).
- Nerve grafts for shoulder abduction showed similar outcomes to nerve transfers (6/10 vs. 5/12 achieved MRC grade ≥3).
- Nerve grafts and nerve transfers for elbow flexion yielded comparable results (4/4 vs. 11/12 achieved MRC grade ≥3).
Conclusions:
- Nerve grafts and nerve transfers offer similar functional outcomes for pediatric traumatic BPI reconstruction.
- Contralateral C7 nerve transfer is not advised for shoulder abduction restoration in pediatric BPI.
- Further research may explore optimal donor sites and techniques for pediatric BPI nerve reconstruction.
Purpose:
To review the demographics and injury patterns in consecutive pediatric patients with traumatic brachial plexus injury presenting to a single center over a 16-year period and to review the outcomes of nerve grafting and nerve transfers for reconstruction of shoulder abduction and elbow flexion in these patients.
Methods:
Forty-five pediatric patients presented for treatment of traumatic Brachial plexus injury from 1996 to 2012. Subgroup analysis of patients who had nerve grafting or nerve transfers for restoration of shoulder abduction and elbow flexion was carried out to compare outcomes of Medical Research Council (MRC) motor grading.
Results:
The mean age of patients was 13.8 years (range, 3-17 y). Panplexal injuries (62%) and upper plexus injuries (16%) were particularly common. There was a very high proportion of preganglionic injuries (91%). Six of the 10 of patients who underwent intraplexal nerve grafting only for restoration of shoulder abduction achieved grade 3 or better power compared with 42% (5/12) of patients who had nerve transfers. When contralateral C7 was used as a donor for nerve transfer in restoration of shoulder abduction, 1 of the 5 patients achieved grade 3 or better shoulder abduction. All 4 patients who had nerve grafts for restoration of elbow flexion achieved grade 3 or better power, compared with 11 of 12 patients who had nerve transfers. There was no statistical difference in outcome (MRC grade 3 or 4) between patients who had nerve grafts and those who had nerve transfers.
Conclusions:
This study shows that nerve grafts can result in similar outcomes (MRC grading) to nerve transfers for restoration of shoulder abduction and elbow flexion in traumatic pediatric BPI. The findings of this study do not support the use of contralateral C7 as a donor for nerve transfer in reconstruction of shoulder abduction in this age group.
Type Of Study/Level Of Evidence:
Therapeutic IV.
