Nerve Transfers for Brachial Plexus Injury: A Pathway to Functional Restoration

The objective of the study is to evaluate the functional outcomes of nerve transfer procedures in adults with post-traumatic irreparable upper root brachial plexus injuries (BPIs).

Design: Retrospective cohort study. Setting: Single-center study conducted at a multi-super-specialty tertiary care hospital. Patient Selection Criteria: Adult patients aged 18-42 years with post-traumatic upper root BPIs (C5-C7) who underwent nerve transfer surgery within 10 months of injury were included. Patients with prior brachial plexus surgery, associated central nervous system injury, or incomplete follow-up were excluded. Outcome Measures and Comparisons: Primary outcome measures included recovery of active shoulder abduction, external rotation, and elbow flexion, assessed using the British Medical Research Council grading system. Outcomes were evaluated at final follow-up and compared with pre-operative functional status.

A total of 26 patients were included, with a mean follow-up duration of 24 months. Statistically significant recovery was observed in shoulder abduction in 88.5% of patients (P < 0.001) and elbow flexion in 84.6% of patients (P < 0.001). Recovery of external rotation was achieved in 30.77% of patients and did not reach statistical significance (P = 0.076). No intraoperative or post-operative complications were reported.

Nerve transfer procedures resulted in significant functional improvement in adults with upper root BPIs. Shoulder abduction and elbow flexion demonstrated reliable recovery following nerve transfer surgery. Restoration of external rotation remained inconsistent and represents an area for further investigation.

Level IV - therapeutic study.