Surgical Options for the Restoration of Elbow Extension After Brachial Plexus Injury

Brachial plexus injuries (BPIs) are devastating and lead to marked functional disability. Injuries involving the proximal radial nerve, posterior cord, or lower cervical nerve roots can lead to triceps palsy and inability to actively extend the elbow. Although not as functionally important as elbow flexion, active elbow extension is required for some activities of daily living, and discussion of reconstructive options with the patient is warranted. Various nerve transfers have been successfully used and may be available, depending on the extent of injury and other surgeries planned or performed. Tendon and free functioning muscle transfers can also have favorable outcomes, particularly in the setting of chronic injuries or after other failed surgeries. This review aims to provide a summary of available options to reconstruct elbow extension after BPI.