Distal Nerve Transfer for Restoring Elbow Extension—Role and Outcome

Abstract

Background In a patient with good hand function, elbow extension is essential for “reaching out” for the objects especially for overhead activities and its absence drastically reduces the working space of the hand. The choice of the procedure for restoration of elbow extension would be quite case-specific; however, in select situations we performed partial nerve transfer of a fascicle of ulnar nerve to the triceps long head motor branch. We, herein, discuss our indications and selection criteria and present outcome in five cases.

Methods Between 2010 and 2020, five patients underwent the procedure as part of the management of their brachial plexus injury who did not require ulnar nerve as a donor for restoration of elbow flexion. Only the patients who underwent nerve transfer surgery were included in the study. Preoperative and postoperative strength of triceps was noted as per Medical Research Council grading.

Results All the five cases in this series recovered antigravity elbow extension at a minimum follow-up of 14 months (grade 4 in 2 and grade 3 in 3 patients). All the patients felt that the procedure improved their function and were extremely satisfied with the outcome.

Conclusion Though elbow flexion reconstruction still remains a priority, in patients with good hand function we always consider innervating the triceps. Restoration of elbow extension greatly improves the overall limb function and patient satisfaction. Ulnar nerve fascicle transfer to the triceps long head was found to be effective and safe.