Rethinking Recovery: Beyond the 18-month Milestone in Nerve Transfer Surgery

Conventional dogma is that recovery following nerve transfer surgery plateaus ∼18 months post operation. This widely accepted notion has shaped patient counselling, patient expectations, and clinical follow-up protocols. This study aims to re-examine the long-term recovery beyond 18 months and present novel findings that challenge the conventional recovery timeline.

A retrospective review of adult patients who underwent nerve transfer surgery more than 5 years ago was conducted. Once identified, these patients were contacted to perform a telephone survey, a qualitative interview, and a clinical re-examination of the reinnervated muscles. Patient-reported outcomes were gathered using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and objective muscle strength was evaluated using the British Medical Research Council (BMRC) scale.

Thirty-one patients were identified for having undergone 37 nerve transfers longer than 5 years ago. The documented 18-month postoperation BMRC grade, 5 years ago, was an average of 3.3/5. Clinical re-examinations of 22 of these patients, a minimum of 5 years post nerve transfer, showed significant improvements in muscle strength, with the average BMRC grade to 4.4/5. Most patients (90.3%) experience continued functional recovery beyond 18 months. The average DASH score, more than 5 years following their nerve transfer, was 24.7, indicating an overall positive functional outcome. Notably, 87.1% of patients resumed work or preinjury activities.

This study suggests that nerve recovery extends beyond the traditionally accepted 18-month timeframe, thereby highlighting the need to amend patient counselling and expectations and revise the follow-up and rehabilitation protocols to optimize long-term success following nerve transfer surgery.