2025, Volume 18, Issue 4, pp 375 – 386

Functional outcomes following nerve transfers for shoulder and elbow reanimation in brachial plexus injuries: a 10-year retrospective study

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Authors and Affiliations

Corresponding author Florin-Vlad Hodea, Department 11, Discipline of Plastic and Reconstructive Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, Bucharest, Romania. E-mail: florin-vlad.hodea@drd.umfcd.ro

Abstract

Brachial plexus injuries are rare but highly disabling, with major implications for upper limb function and quality of life. Nerve transfers have emerged as a key reconstructive technique, particularly valuable in cases where primary repair or grafting is unfeasible or delayed. This retrospective study analysed functional outcomes following nerve transfers in 37 patients with brachial plexus injury. Motor recovery was assessed using the Medical Research Council scale. Patients were stratified by age, timing of surgery, injury severity, and type of nerve transfer performed. The majority of our cohort consisted of male adults, predominantly injured in motorcycle accidents, while pediatric cases were mostly due to obstetrical trauma. For shoulder reanimation, all patients received spinal accessory to suprascapular nerve transfer, with a subset also undergoing medial triceps branch of the radial nerve to axillary nerve transfer. These techniques resulted in 85.3% of patients achieving shoulder function recovery with M3 or M4 muscle strength, with combined procedures leading exclusively to M3 or M4 muscle strength. For elbow flexion restoration, surgical approaches included intercostal to musculocutaneous nerve transfer, ulnar and median fascicles to musculocutaneous nerve transfer, contralateral C7 to musculocutaneous nerve transfer with ulnar graft, and spinal accessory to musculocutaneous nerve transfer with sural nerve graft. Root grafting procedures using sural nerve grafts or nerve conduits were employed in three pediatric patients. Overall, 84.38% of patients achieved elbow flexion recovery with M3 or M4 muscle strength. These findings reinforce the utility of nerve transfers as a cornerstone in the surgical management of brachial plexus injury.

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About this article

PMC ID: 12094303
PubMed ID: 
DOI: 10.25122/jml-2025-0079

Article Publishing Date (print): 4 2025
Available Online: 

Journal information

ISSN Printing: 1844-122X
ISSN Online: 1844-3117
Journal Title: Journal of Medicine and Life

Copyright License: Open Access

This article is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use and redistribution provided that the original author and source are credited.


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