Intercostal nerve transfer to restore upper extremity functions after brachial plexus injury

We report the efficacy of intercostal nerve transfer to restore elbow flexion, shoulder functions, and hand functions. One hundred and twelve patients with loss of elbow flexion were treated with intercostal nerve transfer to the musculocutaneous nerve and 97 (87%) of them regained grade 3 or 4 elbow flexion. Seven patients with loss of shoulder functions were treated with combined intercostal nerve transfer to the axillary nerve and phrenic nerve transfer to the suprascapular nerve, and 4 (57%) of them regained more than 80 degrees abduction and 5 (71%) regained more than 50 degrees external rotation starting with the forearm against the chest. To restore hand functions, intercostal nerves were sutured to the radial nerve or one of its branches in 40 patients and to the median nerve in 10 patients. Motor recovery was poor in both nerve transfers, but protective sensation was regained in the fingers innervated by the median nerve in 9 (90%) of the 10 patients. We conclude that intercostal nerve transfer after brachial plexus injury was a useful procedure to restore elbow flexion and shoulder functions, and for restoring a protective sensation in the fingers.