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DOI: 10.1186/1749-7221-5-4
Comparison between partial ulnar and intercostal nerve transfers for reconstructing elbow flexion in patients with upper brachial plexus injuries[*]
Subject Editor:
Publication History
14 August 2009
26 January 2010
Publication Date:
19 September 2014 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00027212/201001/lookinside/thumbnails/10.1186-1749-7221-5-4-1.jpg)
Abstract
Background There have been several reports that partial ulnar transfer (PUNT) is preferable for reconstructing elbow flexion in patients with upper brachial plexus injuries (BPIs) compared with intercostal nerve transfer (ICNT). The purpose of this study was to compare the recovery of elbow flexion between patients subjected to PUNT and patients subjected to ICNT.
Methods Sixteen patients (13 men and three women) with BPIs for whom PUNT (eight patients) or ICNT (eight patients) had been performed to restore elbow flexion function were studied. The time required in obtaining M1, M3 (Medical Research Council scale grades recovery) for elbow flexion and a full range of elbow joint movement against gravity with the wrist and fingers extended maximally and the outcomes of a manual muscle test (MMT) for elbow flexion were examined in both groups.
Results There were no significant differences between the PUNT and ICNT groups in terms of the age of patients at the time of surgery or the interval between injury and surgery. There were significantly more injured nerve roots in the ICNT group (mean 3.6) than in the PUNT group (mean 2.1) (P = 0.0006). The times required to obtain grades M1 and M3 in elbow flexion were significantly shorter in the PUNT group than in the ICNT group (P = 0.04 for M1 and P = 0.002 for M3). However, there was no significant difference between the two groups in the time required to obtain full flexion of the elbow joint with maximally extended fingers and wrist or in the final MMT scores for elbow flexion.
Conclusions PUNT is technically easy, not associated with significant complications, and provides rapid recovery of the elbow flexion. However, separation of elbow flexion from finger and wrist motions needed more time in the PUNT group than in the ICNT group. Although the final mean MMT score for elbow flexion in the PUNT group was greater than in the ICNT group, no statistically significant difference was found between the two groups.
*This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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References
- 1 Oberlin C, Beal D, Leechavengvongs S, Salon A, Dauge MC, Sarcy JJ. Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of brachial plexus: Anatomical study and report of four cases. J Hand Surg 1994; 19A: 232-237
- 2 Leechavengvongs S, Witoonchart K, Urepairojkit C, Thuvasethakul P, Ketmalasiri W. Nerve transfer to biceps muscle using a part of the ulnar nerve in brachial plexus injury (upper arm type): A report of 32 cases. J Hand Surg 1998; 23A: 711-716
- 3 Seddon HJ. Nerve grafting. J Bone Joint Surg 1963; 45B: 447-455
- 4 Tsuyama N, Hara T. Reconstructive surgery for traumatic brachial plexus injuries. Clin Orthop 1968; 3: 675-687
- 5 Nagano A, Ochiai N, Okinaga S. Restoration of elbow flexion in root lesions of brachial plexus injuries. J Hand Surg 1992; 17: 815-821 10.1016/0363-5023(92)90450-4
- 6 Witoonchart K, Leechavengvons S, Uerpairojkit C, Thuvasethakul P, Wongnopsuwan V. Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, Part 1. J Hand Surg 2003; 28A: 628-632
- 7 Leechavengvons S, Wongnopsuwan V Uerpairojkit C, Thuvasethakul P. Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, Part 2: A case report of 7 cases. J Hand Surg 2003; 28A: 633-638
- 8 Seddon HJ. Peripheral Nerve Injuries. Medical Research Council Special Report Series. 282 Her Majesty’s Stationery Office; London: 1954
- 9 Malessy MJ, van der Kamp W, Thomeer RT, van Dijk JG. Cortical excitability of the biceps muscle after intercostal-to-musculocutaneous nerve transfer. Neurosurgery 1998; 42: 787-794 10.1097/00006123-199804000-00062 9574643
- 10 Malessy MJ, Thomeer RT, van Dijk JG. Changing central nervous system control following intercostal nerve transfer. J Neurosurg 1998; 89: 568-574 10.3171/jns.1998.89.4.0568 9761050
- 11 Malessy MJ, Bakker D, Dekker AJ, Van Duk JG, Thomeer RT. Functional magnetic resonance imaging and control over the biceps muscle after intercostal-musculocutaneous nerve transfer. J Neurosurg 2003; 98: 261-268 10.3171/jns.2003.98.2.0261 12593609
- 12 Marieb E, Hoehn K. Human Anatomy and Physiology. Pearson Benjamin Cummings; San Fransisco: 7 edition 2007
- 13 Merrell GA, Barrie KA, Katz DL, Wolfe SW. Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature. J Hand Surg 2001; 26A: 303-314
- 14 Sungpet A, Suphachatwong C, Kawinwonggowit V, Patradul A. Transfer of a single fascicle from the ulnar nerve to the biceps muscle after avulsions of upper roots of the brachial plexus. J Hand Surg 2000; 25B: 325-8
- 15 Teboul F, Kakkar R, Ameur N, Beaulieu JY, Oberlin C. Transfer of fascicles from the ulnar nerve to the nerve to the biceps in the treatment of upper brachial plexus palsy. J Bone Joint Surg 2004; 86-A: 1485-90 15252097
- 16 Steindler A. Operative treatment of paralytic conditions of the upper extremity. J Orthop Surg 1919; 1: 608
- 17 Mayer L, Green W. Experience with Steindler flexorplasty at the elbow. J Bone Joint Surg 1954; 36A: 775-789