Double Distal Intraneural Fascicular Nerve Transfers for Lower Brachial Plexus Injuries

Purpose: To evaluate outcomes following transfer of the supinator motor branch of the radial nerve (SMB) to the posterior interosseous nerve (PIN) and the pronator teres motor branch of median (PTMB) to the anterior interosseous nerve (AIN) in patients with lower brachial plexus injuries. Methods: Since December 2010, 4 patients have undergone combined transfer of the SMB to PIN and PTMB to AIN for lower brachial plexus palsies. The study was prospectively designed, and the patients were followed for 4 years to monitor their functional improvement. Results: One patient failed to return after his 4-month postoperative visit. The other 3 patients all regained M4 thumb and finger extension, and 2 recovered M4 thumb and finger flexion at the final evaluation, a mean 30 months after the nerve transfer surgeries. Conclusions: Combined transfer of the SMB to PIN and PTMB to AIN may lead to successful recovery of digital extrinsic flexion and extension in lower brachial plexus injuries. Type of study/level of evidence: Therapeutic IV.