Nerve Transfer for the Restoration of Elbow Flexion Following Avulsion Injuries of C5 and C6 Nerve Roots

Restoration of elbow flexion caused by brachial plexus injuries is extremely important. Bridging with neural grafts after avulsion of C5 and C6 nerve roots is not always feasible. Alternative options include tendon or nerve transfers or a combination of both. However, tendon transfer methods yield poor results and nerve transfers (principally intercostal and accessory nerves) do not always guarantee acceptable outcomes. Oberlin et al. (1994) reported very encouraging results in solving the problem through nerve transfer of ulnar nerve fascicles to the fascicle for the biceps brachii of the musculocutaneous nerve.

From 1995 to 2003, 16 patients (14 males and 2 females, aged from 16 to 35 years, with a mean age of 24 years), presenting with an avulsion injury of C5 and C6 nerve roots, were operated on using the method described. The mean postoperative follow-up was 2.5 years (range: 1 to 6 years). Following a short period of immobilization, a rehabilitation program was initiated, including passive mobilization and electrical stimulation.

At 4 months, muscular contractions were noted in all patients and at 6 months, there was weak elbow flexion, which improved significantly at 1 year postoperatively.

This method is simple, reliable, and effective because the motor fascicle of the musculocutaneous nerve is thin and does not require an important sacrifice of a large ulnar nerve part, thus minimizing motor and sensory compromise. The ulnar nerve is situated near the branch to the biceps tendon, allowing end-to-end suturing. Biceps brachii re-innervation is more rapid than with any other method.