Elbow function is most important function to restore in brachial plexus palsy. As it provides for most important function of upper extremity.
Causes
Adult and paediatric brachial plexus injury
spinal cord injury
Nerve injury to elbow flexor
Stab injury
Gunshot injury
Radiation induced neuropathy
When direct repair is not possible nerve transfer is considered.
Common indications for nerve transfer are
Pre ganglionic injury (nerve root avulsions)
High peripheral nerve injury
Delayed presentation (between 6-12 mo)
large neuroma in continuity
innervation for functioning muscle transfer
Timing
Should be performed with in 8 to 9 months after injury. Because motor end plates degenerate after 18 months after injury. Some have done nerve transfer upto 12 months , preferably with in 6 months of injury if feasible.
General principal of nerve transfer
Nerve transfer convert proximal nerve injury to distal nerve injury
Better functional outcome than use of nerve graft as it avoid extra anastomosis
Scarred bed can be avoided
Nerve transfer
Oberlin transfer
Double fascicular transfer
Medial Pectoral nerve
Thoracodorsal Nerve
Intercostal Nerve
Spinal Accessory Nerve (cranial nerveXI)
Contralateral C7
Phrenic Nerve
Hypoglossal nerve
Posterior Branch of the Axillary Nerve
Dr Adhishwar Sharma
MBBS, MS General Surgery PGIMER Chd
Causes
Adult and paediatric brachial plexus injury
spinal cord injury
Nerve injury to elbow flexor
Stab injury
Gunshot injury
Radiation induced neuropathy
When direct repair is not possible nerve transfer is considered.
Common indications for nerve transfer are
Pre ganglionic injury (nerve root avulsions)
High peripheral nerve injury
Delayed presentation (between 6-12 mo)
large neuroma in continuity
innervation for functioning muscle transfer
Timing
Should be performed with in 8 to 9 months after injury. Because motor end plates degenerate after 18 months after injury. Some have done nerve transfer upto 12 months , preferably with in 6 months of injury if feasible.
General principal of nerve transfer
Nerve transfer convert proximal nerve injury to distal nerve injury
Better functional outcome than use of nerve graft as it avoid extra anastomosis
Scarred bed can be avoided
Nerve transfer
Oberlin transfer
Double fascicular transfer
Medial Pectoral nerve
Thoracodorsal Nerve
Intercostal Nerve
Spinal Accessory Nerve (cranial nerveXI)
Contralateral C7
Phrenic Nerve
Hypoglossal nerve
Posterior Branch of the Axillary Nerve
Dr Adhishwar Sharma
MBBS, MS General Surgery PGIMER Chd
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