Clinical Outcome Following Transfer of the Supinator Motor Branch to the Posterior Interosseous Nerve in Patients with C7–T1 Brachial Plexus Palsy

Abstract

Background In cases of C7–T1 brachial plexus palsy, a reliable method for the reconstruction of the finger and thumb extension was not established until the transfer of the supinator motor branch to the posterior interosseous nerve was proposed. The long-term outcome of this new technique requires evaluation due to the limited number of cases and the shorter follow-up period of the previous study.

Objective This study aims to evaluate the long-term effect of the transfer of the supinator motor branch to the posterior interosseous nerve and to determine the recovery time course for this new technique.

Methods A retrospective review was conducted in 10 patients with lower brachial plexus injuries who underwent transfer of the supinator motor branch. Patients were followed up postoperatively for a minimum of 24 months, with all patients scheduled to receive a physical examination and electrophysiological testing every 3 months for the first 2 years.

Results Nine patients (90%) recovered to the Medical Research Council (MRC) grade 3 or better for the extensor digitorum communis. The electrophysiologically documented recovery began at an average of 5.7 months after surgery, with the average time required for the first finger extension being 9.1 months (range 5–18 months), and the average time required for achieving MRC grade 3 being 14.3 months (range 9–24 months). Moreover, no complications or loss of supination was observed in any patient.

Conclusion The supinator motor branch transfer is a safe procedure that yields recovery of finger extension in C7–T1 brachial plexus palsies with encouraging long-term outcomes.

Keywords

brachial plexus - nerve transfer - posterior interosseous nerve - supinator muscle - neurotization

• References

• 1 Gu Y, Wang H, Zhang L, Zhang G, Zhao X, Chen L. Transfer of brachialis branch of musculocutaneous nerve for finger flexion: anatomic study and case report. Microsurgery 2004; 24 (5) 358-362
• 2 Ray WZ, Yarbrough CK, Yee A, Mackinnon SE. Clinical outcomes following brachialis to anterior interosseous nerve transfers. J Neurosurg 2012; 117 (3) 604-609
• 3 Bertelli JA, Ghizoni MF. Brachialis muscle transfer to reconstruct finger flexion or wrist extension in brachial plexus palsy. J Hand Surg Am 2006; 31 (2) 190-196
• 4 Dong Z, Gu YD, Zhang CG, Zhang L. Clinical use of supinator motor branch transfer to the posterior interosseous nerve in C7-T1 brachial plexus palsies. J Neurosurg 2010; 113 (1) 113-117
• 5 Bertelli JA, Ghizoni MF. Transfer of supinator motor branches to the posterior interosseous nerve in C7-T1 brachial plexus palsy. J Neurosurg 2010; 113 (1) 129-132
• 6 Terzis JK, Kokkalis ZT. Selective contralateral c7 transfer in posttraumatic brachial plexus injuries: a report of 56 cases. Plast Reconstr Surg 2009; 123 (3) 927-938
• 7 Lin H, Hou C, Chen A, Xu Z. Transfer of the phrenic nerve to the posterior division of the lower trunk to recover thumb and finger extension in brachial plexus palsy. J Neurosurg 2011; 114 (1) 212-216
• 8 Palazzi S, Palazzi JL, Caceres JP. Neurotization with the brachialis muscle motor nerve. Microsurgery 2006; 26 (4) 330-333
• 9 Bertelli JA, Ghizoni MF, Tacca CP. Transfer of the supinator muscle to the extensor pollicis brevis for thumb extension reconstruction in C7-T1 brachial plexus palsy. J Hand Surg Eur Vol 2010; 35 (1) 29-31
• 10 Soldado F, Bertelli J. Free gracilis transfer reinnervated by the nerve to the supinator for the reconstruction of finger and thumb extension in longstanding C7-T1 brachial plexus root avulsion. J Hand Surg Am 2013; 38 (5) 941-946