Journal articles: 'Musculocutaneous nerve Surgery'

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Samardzic, Miroslav, Danica Grujicic, Lukas Rasulic, and Dragoljub Bacetic. "Transfer of the Medial Pectoral Nerve: Myth or Reality?" Neurosurgery 50, no. 6 (June 1, 2002): 1277–82. http://dx.doi.org/10.1097/00006123-200206000-00019.

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Abstract OBJECTIVE Transfer of the medial pectoral nerve is one of the most controversial procedures used to reinnervate the paralyzed upper arm because of brachial plexus spinal nerve root avulsion or directly irreparable proximal lesions of spinal nerves. The purpose of this study was to determine the value of this type of nerve transfer to the musculocutaneous and axillary nerves. METHODS The 25 patients included in the study comprised 14 patients who had nerve transfer to the musculocutaneous nerve and 11 who underwent nerve transfer to the axillary nerve. These patients’ functional recovery and the time course of their recovery were analyzed according to the type of transfer of one donor nerve or the donor nerve in combination with other donors. RESULTS Useful functional recovery was achieved in 85.7% of patients who had nerve transfer to the musculocutaneous nerve and in 81.8% of patients who underwent nerve transfer to the axillary nerve. There was no significant difference in results with regard to the type of nerve transfer and which recipient nerves were involved. A strong trend toward better results after procedures involving the use of a donor nerve combined with other donors was observed, however. CONCLUSION Our surgical results suggest that the transfer of the medial pectoral nerve to the musculocutaneous nerve and also to the axillary nerve may be a reliable and effective procedure.

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Arora, L., and R. Dhingra. "Unusual nerve supply of biceps from ulnar nerve and median nerve and a third head of biceps." Indian Journal of Plastic Surgery 39, no. 02 (July 2006): 172–74. http://dx.doi.org/10.1055/s-0039-1699152.

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ABSTRACTVariations in branching pattern of the brachial plexus are common and have been reported by several investigators. Of the four main nerves traversing the arm, namely median, ulnar, radial and musculocutaneous, the ulnar and median nerve do not give any branches to muscles of the arm. Ulnar nerve after taking origin from medial cord of brachial plexus runs distally through axilla on medial side of axillary artery till middle of arm, where it pierces the medial intermuscular septum and enters the posterior compartment of arm. Ulnar nerve enters forearm between two heads of flexor carpi ulnaris from where it continues further. It supplies flexor carpi ulnaris , flexor digitorum profundus and several intrinsic muscles of hand . We recently observed dual supply of biceps muscle from ulnar and median nerves in arm. Musculocutaneous nerve was absent. Although communications between nerves in arm is rare, the communication between median nerve and musculocutaneous nerve were described from the 19th century which could explain innervation of biceps from median nerve. But no accurate description of ulnar nerve supplying biceps could be found in literature. Knowledge of anatomical variation of these nerves at level of upper arm is essential in light of the frequency with which surgery is performed to transfer nerve fascicles from ulnar nerve to biceps in case of brachial plexus injuries. We also observed third head of biceps, our aim is to describe the exact topography of this variation and to discuss its morphological.

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Haninec, Pavel, Libor Mencl, and Radek Kaiser. "End-to-side neurorrhaphy in brachial plexus reconstruction." Journal of Neurosurgery 119, no. 3 (September 2013): 689–94. http://dx.doi.org/10.3171/2013.6.jns122211.

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Object Although a number of theoretical and experimental studies dealing with end-to-side neurorrhaphy (ETSN) have been published to date, there is still a considerable lack of clinical trials investigating this technique. Here, the authors describe their experience with ETSN in axillary and musculocutaneous nerve reconstruction in patients with brachial plexus palsy. Methods From 1999 to 2007, out of 791 reconstructed nerves in 441 patients treated for brachial plexus injury, the authors performed 21 axillary and 2 musculocutaneous nerve sutures onto the median, ulnar, or radial nerves. This technique was only performed in patients whose donor nerves, such as the thoracodorsal and medial pectoral nerves, which the authors generally use for repair of axillary and musculocutaneous nerves, respectively, were not available. In all patients, a perineurial suture was carried out after the creation of a perineurial window. Results The overall success rate of the ETSN was 43.5%. Reinnervation of the deltoid muscle with axillary nerve suture was successful in 47.6% of the patients, but reinnervation of the biceps muscle was unsuccessful in the 2 patients undergoing musculocutaneous nerve repair. Conclusions The authors conclude that ETSN should be performed in axillary nerve reconstruction but only when commonly used donor nerves are not available.

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Devale, Maksud Mubarak, Gaurav Jatin Kadakia, Vicky Ghewarchand Jain, and Rohit Prakash Munot. "Direct electrical injury to brachial plexus." Indian Journal of Plastic Surgery 50, no. 02 (May 2017): 217–19. http://dx.doi.org/10.4103/ijps.ijps_177_16.

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ABSTRACTElectrical current can cause neurological damage directly or by conversion to thermal energy. However, electrical injury causing isolated brachial plexus injury without cutaneous burns is extremely rare. We present a case of a 17-year-old boy who sustained accidental electrical injury to left upper extremity with no associated entry or exit wounds. Complete motor and sensory loss in upper limb were noted immediately after injury. Subsequently, the patient showed partial recovery in muscles around the shoulder and in ulnar nerve distribution at 6 months. However, there was no improvement in muscles supplied by musculocutaneous, median and radial nerves. On exploration at 6 months after trauma, injury to the infraclavicular plexus was identified. Reconstruction of musculocutaneous, median and radial nerves by means of sural nerve cable grafts was performed. The patient has shown excellent recovery in musculocutaneous nerve function with acceptable recovery of radial nerve function at 1-year post-injury.

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Kubwimana, Olivier, Albert Ndata, Andrew Ivang, Paul Ndahimana, Albert Nzayisenga, Jean Claude Byiringiro, and Julien Gashegu. "Musculocutaneous and median nerve branching: anatomical variations. Case Series from UR clinical anatomy and literature review." African Health Sciences 22, no. 1 (April 29, 2022): 263–8. http://dx.doi.org/10.4314/ahs.v22i1.33.

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Introduction: The brachial plexus is highly variable, which is a well-known anatomical fact. Repeated observations on anatomical variations, however, constitute current trends in anatomical research. Case series: In an anatomical dissection course, three uncommon variations in the brachial plexus were identified in three young adults’ cadavers. In one case, the musculocutaneous nerve gave a branch to the median nerve, while the median nerve gave or received musculocutaneous branches in the two remaining corpses. Conclusion: Anatomical variations of the brachial plexus do occur in our setting. The cases we presented are about anatomical variations of branching patterns of the median and musculocutaneous nerves. Knowledge of those variations is essential for surgery and regional anesthesia of the upper limbs. Keywords: Anatomical variations; brachial plexus; median nerve; musculocutaneous nerve; upper limb.

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Blaauw, Gerhard, and Albert C. J. Slooff. "Transfer of Pectoral Nerves to the Musculocutaneous Nerve in Obstetric Upper Brachial Plexus Palsy." Neurosurgery 53, no. 2 (August 1, 2003): 338–42. http://dx.doi.org/10.1227/01.neu.0000073420.66113.66.

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Abstract OBJECTIVE To investigate the results of transfer of pectoral nerves to the musculocutaneous nerve for treatment of obstetric brachial palsy. METHODS In 25 cases of obstetric brachial palsy (20 after breech deliveries), branches of the pectoral nerve plexus were transferred directly to the musculocutaneous nerve. For all patients, the nerve transfer was part of an extended brachial plexus reconstruction. Results were tested both clinically and with the Mallet scale, at a mean follow-up time of 70 months (standard deviation, 34.3 mo). RESULTS There were two complete failures, which were attributable to disconnection of the transferred nerve endings. The results after transfer were excellent in 17 cases and fair in 5 cases. Steindler flexorplasty improved elbow flexion for three patients. CONCLUSION Transfer of pectoral nerves to the musculocutaneous nerve for treatment of obstetric upper brachial palsy may be effective, if the specific anatomic features of the pectoral nerve plexus are sufficiently appreciated.

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KRISHNAMURTHY, A., S. R. NAYAK, L. VENKATRAYA PRABHU, R. P. HEGDE, S. SURENDRAN, M. KUMAR, and M. M. PAI. "The Branching Pattern and Communications of the Musculocutaneous Nerve." Journal of Hand Surgery (European Volume) 32, no. 5 (October 2007): 560–62. http://dx.doi.org/10.1016/j.jhse.2007.06.003.

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Anatomical variations of peripheral nerves are important and can help explain otherwise incomprehensible clinical findings. A study of 26 right and 18 left formalin-preserved upper limbs identified the fact that the musculocutaneous nerve is subject to considerable anatomical variation, including communication with the median nerve. A study of its branching pattern made us aware of why debility after trauma to the lateral aspect of the upper arm may be more than expected, and this study considers the clinical and surgical importance of these variations of the musculocutaneous nerve.

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Lam, W. L., D. Fufa, N. J. Chang, and D. C. C. Chuang. "Management of infraclavicular (Chuang Level IV) brachial plexus injuries: A single surgeon experience with 75 cases." Journal of Hand Surgery (European Volume) 40, no. 6 (October 7, 2014): 573–82. http://dx.doi.org/10.1177/1753193414553753.

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Infraclavicular brachial plexus injuries (Level IV in Chuang’s classification) have special characteristics, including high incidences of associated scapular fractures, glenohumeral dislocations, and vascular injuries. In addition, there are specific difficulties in surgical dissection and nerve repairs, especially if surgery is delayed (>3 months). A total of 153 patients with Level IV brachial plexus injuries underwent surgery between 1987 and 2008 with 75 patients (average age 29 years) available for a minimum of 4 years follow-up. Accompanying fractures/dislocations were suffered by 48 (64%) patients, and 17 (23%) had associated vascular injuries. The most common nerves to be injured were the axillary and musculocutaneous nerves. Nerve grafts to the axillary, musculocutaneous, and radial nerves achieved impressive results, but less reliable outcomes were achieved with the median and ulnar nerves. Decompression and/or external neurolysis were also beneficial for nerve recovery. Some surgical tips are presented, and the use of the C-loop vascularized ulnar nerve graft and functioning muscle transfers are discussed. Level of Evidence: IV

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V., Dhanalakshmi, Santhi B., and Suba Ananthi K. "Bilateral communication between musculocutaneous nerve and median nerve - a case report." National Journal of Clinical Anatomy 01, no. 02 (April 2012): 096–98. http://dx.doi.org/10.1055/s-0039-3401661.

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AbstractDuring routine dissection of an adult male cadaver, we observed bilateral communication between musculocutaneous nerve and median nerve. The level of origin of the communicating branch from musculocutaneous nerve was different in both arms. In left arm it arose before piercing coracobrachialis and in the right arm after piercing it. It is important to be aware of this variation while planning a surgery in the region of arm, as these nerves are more liable to be injured during operations. Any compression over the communicating branch may give rise to varying patterns of weakness that may impose difficulty in diagnosis for the neurologists.

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Samii, Amir, Gustavo Adolpho Carvalho, and Madjid Samii. "Brachial plexus injury: factors affecting functional outcome in spinal accessory nerve transfer for the restoration of elbow flexion." Journal of Neurosurgery 98, no. 2 (February 2003): 307–12. http://dx.doi.org/10.3171/jns.2003.98.2.0307.

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Object. Between 1994 and 1998, 44 nerve transfers were performed using a graft between a branch of the accessory nerve and musculocutaneous nerve to restore the flexion of the arm in patients with traumatic brachial plexus injuries. A retrospective study was conducted, including statistical evaluation of the following pre- and intraoperative parameters in 39 patients: 1) time interval between injury and surgery; and 2) length of the nerve graft used to connect the accessory and musculocutaneous nerves. Methods. The postoperative follow-up interval ranged from 23 to 84 months, with a mean ± standard deviation of 36 ± 13 months. Reinnervation of the biceps muscle was achieved in 72% of the patients. Reinnervation of the musculocutaneous nerve was demonstrated in 86% of the patients who had undergone surgery within the first 6 months after injury, in 65% of the patients who had undergone surgery between 7 and 12 months after injury, and in only 50% of the patients who had undergone surgery 12 months after injury. A statistical comparison of the different preoperative time intervals (0–6 months compared with 7–12 months) showed a significantly better outcome in patients treated with early surgery (p < 0.05). An analysis of the impact of the length of the interposed nerve grafts revealed a statistically significant better outcome in patients with grafts 12 cm or shorter compared with that in patients with grafts longer than 12 cm (p < 0.005). Conclusions. Together, these results demonstrated that outcome in patients who undergo accessory to musculocutaneous nerve neurotization for restoration of elbow flexion following brachial plexus injury is greatly dependent on the time interval between trauma and surgery and on the length of the nerve graft used.

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Osborne, A. W. H., R. M. Birch, P. Munshi, and G. Bonney. "The musculocutaneous nerve." Journal of Bone and Joint Surgery. British volume 82-B, no. 8 (November 2000): 1140–42. http://dx.doi.org/10.1302/0301-620x.82b8.0821140.

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ROUKOZ, S., N. NACCACHE, and G. SLEILATY. "The Role of the Musculocutaneous and Radial Nerves in Elbow Flexion and Forearm Supination: A Biomechanical Study." Journal of Hand Surgery (European Volume) 33, no. 2 (April 2008): 201–4. http://dx.doi.org/10.1177/1753193408087036.

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The intention of this prospective study was to evaluate the role of the musculocutaneous and radial nerves in elbow flexion and forearm supination. The study included 29 patients having loco-regional anaesthesia for minor hand surgery. Elbow flexion and forearm supination forces were evaluated before and after an isolated musculocutaneous nerve block in one group and an isolated radial nerve block in another group. The results showed that the biceps tendon is responsible for 47% of the forearm supination force and the combination of brachioradialis and the supinator for 64% of this force. It showed also that the musculocutaneous and radial nerves contribute by 42% and 27.5%, respectively, to the flexion force of the elbow. These results are intended to help surgeons in decision making when treating chronic biceps tendon rupture, in repair of traumatic brachial plexus neuropathy and in using tendon transfers, such as the Steindler transfer, around the elbow.

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Cage, Tene A., Neil G. Simon, Suzanne Bourque, Roger Noss, John W. Engstrom, Jeffrey W. Ralph, and Michel Kliot. "Dual reinnervation of biceps muscle after side-to-side anastomosis of an intact median nerve and a damaged musculocutaneous nerve." Journal of Neurosurgery 119, no. 4 (October 2013): 929–33. http://dx.doi.org/10.3171/2013.5.jns122359.

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Traumatic peripheral nerve injury can lead to significant long-term disability for previously healthy persons. Damaged nerve trunks have been traditionally repaired using cable grafts, but nerve transfer or neurotization procedures have become increasingly popular because the axonal regrowth distances are much shorter. These techniques sacrifice the existing nerve pathway, so muscle reinnervation depends entirely on the success of the repair. Providing a supplemental source of axons from an adjacent intact nerve by using side-to-side anastomosis might reinnervate the target muscle without compromising the function of the donor nerve. The authors report a case of biceps muscle reinnervation after side-to-side anastomosis of an intact median nerve to a damaged musculocutaneous nerve. The patient was a 34-year-old man who had sustained traumatic injury primarily to the right upper and middle trunks of the brachial plexus. At 9 months after the injury, because of persistent weakness, the severely damaged upper trunk of the brachial plexus was repaired with an end-to-end graft. When 8 months later biceps function had not recovered, the patient underwent side-to-side anastomosis of the intact median nerve to the adjacent distal musculocutaneous nerve via epineural windows. By 9 months after the second surgery, biceps muscle function had returned clinically and electrodiagnostically. Postoperative electromyographic and nerve conduction studies confirmed that the biceps muscle was being reinnervated partly by donor axons from the healthy median nerve and partly by the recovering musculocutaneous nerve. This case demonstrates that side-to-side anastomosis of an intact median to an injured musculocutaneous nerve can provide dual reinnervation of the biceps muscle while minimizing injury to both donor and recipient nerves.

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Kim, Eun Jin, and Kyoung-Eun Kim. "Indirect traumatic musculocutaneous nerve injury confused with static line injury: A case report." Neurology Asia 26, no. 3 (September 2021): 613–16. http://dx.doi.org/10.54029/2021ddf.

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The musculocutaneous nerve is rarely injured because it is short and is located deep in the shoulder and arm. Damage is usually caused by direct injuries, including stabbing, explosion, and surgery in a war setting. Although indirect injury of the musculocutaneous nerve is extremely rare, it occurs in various situations. In military parachuting-related activities, musculoskeletal injury occurs most commonly, and static line injury is known as rupture of the biceps brachii tendon. However, musculocutaneous neuropathy can also result from secondary injury by the static line. The musculocutaneous nerve goes together with the biceps brachii muscle, and the musculocutaneous nerve could overstretch and compress within the coracobrachialis muscle where the nerve is relatively fixed due to the overloading of the upper arm with shoulder extension. This report focuses on the indirect musculocutaneous nerve injury with axonotmesis following an overloading event by the static line during military parachuting. In this case, some physicians may confuse nerve injury with static line injury, leading to delays in the diagnosis of neuropathy. If the biceps brachii muscle is damaged due to trauma, checking for the accompanying musculocutaneous nerve injury is necessary.

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Bertelli, Jayme Augusto, and Marcos Flávio Ghizoni. "Grafting the C5 Root to the Musculocutaneous Nerve Partially Restores Hand Sensation in Complete Palsies of the Brachial Plexus." Neurosurgery 71, no. 2 (April 2, 2012): 259–63. http://dx.doi.org/10.1227/neu.0b013e3182571971.

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Abstract BACKGROUND: In complete brachial plexus palsy, we have hypothesized that grafting to the musculocutaneous nerve should restore some hand sensation because the musculocutaneous nerve can drive hand sensation directly or via communication with the radial and median nerves. OBJECTIVE: To investigate sensory recovery in the hand and forearm after C5 root grafting to the musculocutaneous nerve in patients with a total brachial plexus injury. METHODS: Eleven patients who had recovered elbow flexion after musculocutaneous nerve grafting from a preserved C5 root and who had been followed for a minimum of 3 years were screened for sensory recovery in the hand and forearm. Six matched patients who had not undergone surgery served as controls. Methods of assessment included testing for pain sensation using Adson forceps, cutaneous pressure threshold measurements using Semmes-Weinstein monofilaments, and the static 2-point discrimination test. Deep sensation was evaluated by squeezing the first web space, and thermal sensation was assessed using warm and cold water. RESULTS: All grafted patients recovered sensation in a variable territory extending from just over the thenar eminence to the entire lateral forearm and hand. Seven patients were capable of perceiving 2-0 monofilament pressure on the thenar eminence, palm, and dorsoradial aspect of the hand. All could differentiate warm and cold water. None recovered 2-point discrimination. None of the patients in the control group recovered any kind of sensation in the affected limb. CONCLUSION: Grafting the musculocutaneous nerve can restore nociceptive sensation on the radial side of the hand.

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Darvishi, Marzieh, and Ardeshir Moayeri. "Anatomical Variations of the Musculocutaneous and Median Nerves: A Case Report." Folia Medica 61, no. 2 (June 1, 2019): 327–31. http://dx.doi.org/10.2478/folmed-2018-0080.

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Abstract The musculocutaneous nerve is a large terminal branch of the lateral cord of the brachial plexus. It passes under the pectoralis minor and penetrates the coracobrachialis muscle, descending between the biceps brachii and brachialis muscles in the arm. After dissection in upper extremities in a 28-year-old male cadaver, the median and musculocutaneous nerve were found to have variations on the right side where the musculocutaneous nerve formed communications with the median nerve. The median nerve innervated muscles of the front of the arm in this cadaver. In addition, the musculocutaneous nerve did not pierce the coracobrachialis muscle on the right side. Knowledge of these variations is extremely important when planning a surgery in the region of axilla.

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Samii, Madjid, Gustavo A. Carvalho, Guido Nikkhah, and Götz Penkert. "Surgical reconstruction of the musculocutaneous nerve in traumatic brachial plexus injuries." Journal of Neurosurgery 87, no. 6 (December 1997): 881–86. http://dx.doi.org/10.3171/jns.1997.87.6.0881.

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✓ Over the last 16 years, 345 surgical reconstructions of the brachial plexus were performed using nerve grafting or neurotization techniques in the Neurosurgical Department at the Nordstadt Hospital, Hannover, Germany. Sixty-five patients underwent graft placement between the C-5 and C-6 root and the musculocutaneous nerve to restore the flexion of the arm. A retrospective study was conducted, including statistical evaluation of the following pre- and intraoperative parameters in 54 patients: 1) time interval between injury and surgery; 2) choice of the donor nerve (C-5 or C-6 root); and 3) length of the grafts used for repairs between the C-5 or C-6 root and the musculocutaneous nerve. The postoperative follow-up interval ranged from 9 months to 14.6 years, with a mean ± standard deviation of 4.4 ± 3 years. Reinnervation of the biceps muscle was found in 61% of the patients. Comparison of the different preoperative time intervals (1–6 months, 7–12 months, and > 12 months) showed a significantly better outcome in those patients with a preoperative delay of less than 7 months (p < 0.05). Reinnervation of the musculocutaneous nerve was demonstrated in 76% of the patients who underwent surgery within the first 6 months postinjury, in 60% of the patients with a delay of between 6 and 12 months, and in only 25% of the patients who underwent surgery after 12 months. Comparison of the final outcome according to the root (C-5 or C-6) that was used for grafting the musculocutaneous nerve showed no statistical difference. Furthermore, statistical analysis (regression test) of the length of the grafts between the donor (C-5 or C-6 root) nerve and the musculocutaneous nerve displayed an inverse relationship between the graft length and the postoperative outcome. Together, these results provide additional information to enhance the functional outcome of brachial plexus surgery.

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Nagwani, Mumal, Archana Rani, Anita Rani, Jyoti Chopra, Ajai Kumar Srivastava, and Pradeep Kumar Sharma. "A Variant Course of Lateral Root of Median Nerve: Embryological Basis." Asian Journal of Medical Sciences 5, no. 2 (December 11, 2013): 146–50. http://dx.doi.org/10.3126/ajms.v5i2.8195.

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During routine dissection of the right arm of 50 year old male cadaver, we observed that the lateral root of median nerve was piercing the coracobrachialis muscle before joining the medial root of median to form the median nerve. The lateral root of median nerve did not give any branch within the muscle and no communication was observed between musculocutaneous nerve and lateral root of median nerve within the coracobrachialis muscle or in the later course of these two nerves. The same muscle was being pierced by musculocutaneous nerve which was giving branches to the muscle. These variations are important for the anesthetists, surgeons, neurologists during surgery and anatomists during dissection in the region of axilla. DOI: http://dx.doi.org/10.3126/ajms.v5i2.8195 Asian Journal of Medical Science, Volume-5(2) 2014: 146-150

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Samii, Madjid, Gustavo A. Carvalho, Guido Nikkhah, and Götz Penkert. "Surgical reconstruction of the musculocutaneous nerve in traumatic brachial plexus injuries." Neurosurgical Focus 3, no. 4 (October 1997): E2. http://dx.doi.org/10.3171/foc.1997.3.4.2.

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Over the last 16 years, 345 surgical reconstructions of the brachial plexus were performed using nerve grafting or neurotization techniques in the Neurosurgical Department at the Nordstadt Hospital, Hannover, Germany. Sixty-five patients underwent graft placement between the C-5 and C-6 root and the musculocutaneous nerve to restore the flexion of the arm. A retrospective study was conducted, including statistical evaluation of the following pre- and intraoperative parameters in 54 patients: 1) time interval between injury and surgery; 2) choice of the donor nerve (C-5 or C-6 root); and 3) length of the grafts used for repairs between the C-5 or C-6 root and the musculocutaneous nerve. The postoperative follow-up interval ranged from 9 months to 14.6 years, with a mean ± standard deviation of 4.4 ± 3 years. Reinnervation of the biceps muscle was found in 61% of the patients. Comparison of the different preoperative time intervals (1-6 months, 7-12 months, and > 12 months) showed a significantly better outcome in those patients with a preoperative delay of less than 7 months (p < 0.05). Reinnervation of the musculocutaneous nerve was demonstrated in 76% of the patients who underwent surgery within the first 6 months postinjury, in 60% of the patients with a delay of between 6 and 12 months, and in only 25% of the patients who underwent surgery after 12 months. Comparison of the final outcome according to the root (C-5 or C-6) that was used for grafting the musculocutaneous nerve showed no statistical difference. Furthermore, statistical analysis (regression test) of the length of the grafts between the donor (C-5 or C-6 root) nerve and the musculocutaneous nerve displayed an inverse relationship between the graft length and the postoperative outcome. Together, these results provide additional information to enhance the functional outcome of brachial plexus surgery.

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Davidson, James J., Frank H. Bassett, and James A. Nunley. "Musculocutaneous nerve entrapment revisited." Journal of Shoulder and Elbow Surgery 7, no. 3 (May 1998): 250–55. http://dx.doi.org/10.1016/s1058-2746(98)90053-2.

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Hu, Shao-nan, Wen-jun Zhou, Huan Wang, Liang Chen, Yi Zhu, Yu-Dong Gu, and Jian-Guang Xu. "ORIGINATION OF THE BRACHIALIS BRANCH OF THE MUSCULOCUTANEOUS NERVE." Neurosurgery 62, no. 4 (April 1, 2008): 908–12. http://dx.doi.org/10.1227/01.neu.0000318176.13214.70.

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Abstract OBJECTIVE To test an innovative method to study the origin of a specific nerve or of the nerve fibers innervating a given muscle on the healthy upper limb of a human being and to find the rationale for the brachialis branch of musculocutaneous nerve transfer. METHODS An intraoperative electrophysiological study was conducted comprising 27 cases of contralateral C7 transfer. The goal of the study was to record compound muscle action potential of the brachialis muscle while various nerve roots of the brachial plexus were stimulated. RESULTS Analysis of compound muscle action potential suggested that the brachialis branch of the musculocutaneous nerve is composed of fibers from the C5, C6, and C7 nerve roots and that the C5 and C6 nerve roots are the major origin for the brachialis branch of musculocutaneous nerve fibers. CONCLUSION The technique proposed here was a more direct and functional method of tracing the origin of a specific nerve or of the nerve fibers innervating a given muscle on the healthy upper limb of a live patient.

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Malessy, Martijn J. A., and Ralph T. W. M. Thomeer. "Evaluation of intercostal to musculocutaneous nerve transfer in reconstructive brachial plexus surgery." Journal of Neurosurgery 88, no. 2 (February 1998): 266–71. http://dx.doi.org/10.3171/jns.1998.88.2.0266.

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Object. Direct coaptation of intercostal nerves (ICNs) to the musculocutaneous (MC) nerve was performed to restore elbow flexion in 25 patients with brachial plexus root avulsions. Methods. Seventy-five ICNs were transected as close as possible to the sternum to obtain sufficient length and then tunneled to the axilla and coapted to the MC nerve. Direct coaptation was achieved in 95% of ICNs, and functional elbow flexion was regained in 64% of the patients. The results were compared with several reported transfer techniques in which either an ICN or other donor nerves were used. Conclusions. Direct coaptation was equally effective and more straightforward than transfers involving interposition of grafts. The use of alternative donors such as the accessory nerve carries inherent disadvantages compared with the use of ICNs, and the results are not substantially better. Direct ICN—MC nerve transfer is a valuable reconstructive procedure.

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Tubbs, R. Shane, Marios Loukas, Mohammadali M. Shoja, Ghaffar Shokouhi, John C. Wellons, W. Jerry Oakes, and Aaron A. Cohen-Gadol. "The contralateral long thoracic nerve as a donor for upper brachial plexus neurotization procedures: cadaveric feasibility study." Journal of Neurosurgery 110, no. 4 (April 2009): 749–53. http://dx.doi.org/10.3171/2008.4.17511.

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Object Various donor nerves, including the ipsilateral long thoracic nerve (LTN), have been used for brachial plexus neurotization procedures. Neurotization to proximal branches of the brachial plexus using the contralateral long thoracic nerve (LTN) has, to the authors' knowledge, not been previously explored. Methods In an attempt to identify an additional nerve donor candidate for proximal brachial plexus neurotization, the authors dissected the LTN in 8 adult human cadavers. The nerve was transected at its distal termination and then passed deep to the clavicle and axillary neurovascular bundle. This passed segment of nerve was then tunneled subcutaneously and contralaterally across the neck to a supra- and infraclavicular exposure of the suprascapular and musculocutaneous nerves. Measurements were made of the length and diameter of the LTN. Results All specimens were found to have a LTN that could be brought to the aforementioned contralateral nerves. Neural connections remained tension free with left and right neck rotation of ~ 45°. The mean length of the LTN was 22 cm with a range of 18–27 cm. The overall mean diameter of this nerve was 3.0 mm. No gross evidence of injury to surrounding neurovascular structures was identified in any specimen. Conclusions Based on the results of this cadaveric study, the use of the contralateral LTN may be considered for neurotization of the proximal musculocutaneous and suprascapular nerves.

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Arora, L., and R. Dhingra. "Absence of musculocutaneous nerve and accessory head of biceps brachii: a case report." Indian Journal of Plastic Surgery 38, no. 02 (July 2005): 114–46. http://dx.doi.org/10.1055/s-0039-1699123.

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ABSTRACTDuring dissection of a 55-year-old female cadaver, we observed that three nerve roots contributed to the formation of Median nerve in her right upper limb. Along with this variation, absence of Musculocutaneous nerve was noticed. The muscles of front of arm i.e. Biceps Brachii, Brachialis and Coracobrachialis received their nerve supply from Median nerve. The Lateral cutaneous nerve of forearm was derived from Median nerve. Also an accessory head of Biceps Brachii muscle was present in the right arm of the same cadaver. It is extremely important to be aware of these variations while planning a surgery in the region of axilla or arm as these nerves are more liable to be injured during operations.

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Ferraresi, Stefano, Debora Garozzo, and Paolo Buffatti. "Reinnervation of the biceps in C5–7 brachial plexus avulsion injuries: results after distal bypass surgery." Neurosurgical Focus 16, no. 5 (May 2004): 1–4. http://dx.doi.org/10.3171/foc.2004.16.5.7.

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Object The authors report various techniques, and their results, after performing median and ulnar nerve transfers to reanimate the biceps muscle in C5–7 avulsion-related brachial plexus injuries (BPIs). Methods Forty-three adult patients with BPIs of the upper-middle plexus underwent reinnervation of the biceps muscle; neurotization of the musculocutaneous nerve was performed using fascicles from the ulnar nerve (39 cases) and the median nerve (four cases). The different techniques included sectioning, rerouting, and direct suturing of the entire musculocutaneous nerve (35 cases); direct reinnervation of the motor branches of the musculocutaneous nerve (three cases); and reinnervation using small grafts to the motor fascicles that enter the biceps muscle (five cases). Elbow flexion recovery ranged from M2 to M4+, according to the patient's age and the level of integrity of the hand. No surgery-related failure occurred. No significant difference in outcome was related to any of the technical variants. In patients younger than age 45 years and exhibiting a normal hand function a score of M4 or better was always achieved. On average, reinnervation occurred 6 months after surgery. There was no clinical evidence of donor nerve dysfunction. Conclusions When accurate selection criteria are met, the results after this type of neurotization have proved excellent.

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Pankaj, Arvind Kumar, CS Ramesh Babu, Archana Rani, Anita Rani, Jyoti Chopra, Rakesh Kumar Verma, Navneet Kumar, and Ajay Kumar Srivastava. "Absence of Musculocutaneous Nerve: Embryological Basis." Asian Journal of Medical Sciences 3, no. 2 (February 26, 2013): 21–24. http://dx.doi.org/10.3126/ajms.v3i2.6626.

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Variation of brachial plexus characterized by the absence of musculocutaneous nerve in right arm was found during routine dissection of a 54 year old male cadaver. After giving lateral pectoral nerve, rest of the lateral cord continued as lateral root of median nerve. An unusual branch was arising from lateral cord which crossed the axillary artery anteriorly and then divided into two branches. One of these branches joined ulnar nerve and other medial root of median nerve. All the muscles of front of arm were supplied by branches of median nerve. These variations are important for the anesthetists, surgeons, neurologists during surgery and for anatomists during dissection in the region of axilla. DOI: http://dx.doi.org/10.3126/ajms.v3i2.6626 Asian Journal of Medical Sciences 3(2012) 21-24

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Toussaint, Charles P., and Eric L. Zager. "The Double Fascicular Nerve Transfer for Restoration of Elbow Flexion." Operative Neurosurgery 68, suppl_1 (March 1, 2011): ons64—ons67. http://dx.doi.org/10.1227/neu.0b013e31820958e8.

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Abstract BACKGROUND: Injuries to the upper trunk of the brachial plexus are debilitating, affecting primarily shoulder abduction and elbow flexion. Treatment is aimed at restoring shoulder stabilization, shoulder abduction, and elbow flexion and may be accomplished by nerve grafting, nerve transfer, or functional muscular transfer. OBJECTIVE: To describe the double fascicular nerve transfer with the goal of restoring elbow flexion. METHODS: The double fascicular nerve transfer involves transferring an ulnar nerve fascicle to the musculocutaneous nerve innervating the biceps muscle and a median nerve fascicle transfer to a branch of musculocutaneous nerve supplying the brachialis muscle. RESULTS: The double fascicular nerve transfer is effective in restoring elbow flexion after severe upper-trunk brachial plexus injuries. CONCLUSION: Advantages of this procedure are that the nerve repair is done very close to the target muscle for reinnervation, so time to reinnervation is minimized, and the surgery takes place distal to the site of injury in nontraumatized tissue.

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Pondaag, W., and M. J. A. Malessy. "Intercostal and pectoral nerve transfers to re-innervate the biceps muscle in obstetric brachial plexus lesions." Journal of Hand Surgery (European Volume) 39, no. 6 (August 12, 2013): 647–52. http://dx.doi.org/10.1177/1753193413501588.

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In obstetric brachial plexus lesions with avulsion injury, nerve grafting for biceps muscle re-innervation may not be possible owing to the unavailability of a proximal stump. In such cases, the intercostal nerves or medial pectoral nerve can serve as donor nerves in an end-to-end transfer to the musculocutaneous nerve. The present study reports the results of both techniques from a single institution in a consecutive series of 42 patients between 1995 and 2008. From 1995 to 2000 we always used the intercostal nerve transfer, and from 2001 to 2008 both techniques were used. Biceps muscle force ≥Medical Research Council Grade 3 was achieved in 37 of 42 patients after a mean follow-up of 44 months. There was no statistical difference in the results in the medial pectoral nerve transfer group ( n = 25) and the intercostal nerve transfer group ( n = 17).

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Samard˘zić, Miroslav, Lukas Rasulić, Danica Gruji˘cić, and Biljana Mili˘cić. "Results of Nerve Transfers to the Musculocutaneous and Axillary Nerves." Neurosurgery 46, no. 1 (January 1, 2000): 93–103. http://dx.doi.org/10.1093/neurosurgery/46.1.93.

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Samardzic, Miroslav, Lukas Rasulic, Novak Lakicevic, Vladimir Bascarevic, Irena Cvrkota, Mirko Micovic, and Andrija Savic. "Collateral branches of the brachial plexus as donors in nerve transfers." Vojnosanitetski pregled 69, no. 7 (2012): 594–603. http://dx.doi.org/10.2298/vsp110301007s.

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Background/Aim. Nerve transfers in cases of directly irreparable, or high level extensive brachial plexus traction injuries are performed using a variety of donor nerves with various success but an ideal method has not been established. The purpose of this study was to analyze the results of nerve transfers in patients with traction injuries to the brachial plexus using the thoracodorsal and medial pectoral nerves as donors. Methods. This study included 40 patients with 25 procedures using the thoracodorsal nerve and 33 procedures using the medial pectoral nerve as donors for reinnervation of the musculocutaneous or axillary nerve. The results were analyzed according to the donor nerve, the age of the patient and the timing of surgery. Results. The total rate of recovery for elbow flexion was 94.1%, for shoulder abduction 89.3%, and for shoulder external rotation 64.3%. The corresponding rates of recovery using the thoracodorsal nerve were 100%, 93.7% and 68.7%, respectively. The rates of recovery with medial pectoral nerve transfers were 90.5%, 83.3% and 58.3%, respectively. Despite the obvious differences in the rates of recovery, statistical significance was found only between the rates and quality of recovery for the musculocutaneous and axillary nerve using the thoracodorsal nerve as donor. Conclusion. According to our findings, nerve transfers using collateral branches of the brachial plexus in cases with upper palsy offer several advantages and yield high rate and good quality of recovery.

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Valcarenghi, Jérôme, Fabian Moungondo, Aurélie Andrzejewski, Véronique Feipel, and Frédéric Schuind. "Effects of humeral shortening on the three-dimensional configuration of the brachial plexus: a cadaveric study." Journal of Hand Surgery (European Volume) 44, no. 6 (March 25, 2019): 632–39. http://dx.doi.org/10.1177/1753193419837485.

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This study reports the gains in length of nerves after three different humeral shortenings. Ten brachial plexuses were dissected. The lengths of the different parts of the brachial plexus were measured using a three-dimensional digitizing system after humeral shaft shortenings of 2, 4 and 6 cm and after a standardized force of 0.588 N was used to apply tension to the plexus. The feasibility of nerve suturing was studied. Humeral shortening allowed for significant gains in lengths of the musculocutaneous (42 mm), median (41 mm), ulnar (29 mm) and radial nerves (15 mm). A 2 cm humeral shortening allowed a 2 cm nerve gap to be directly sutured in 70% to 90% of cases. This study suggests that humeral shortening could allow direct suture of nerve defects, or shorten the length of nerve grafts required to bridge a gap.

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Samardzic, Miroslav, Danica Grujicic, and Vaso Antunovic. "Nerve transfer in brachial plexus traction injuries." Journal of Neurosurgery 76, no. 2 (February 1992): 191–97. http://dx.doi.org/10.3171/jns.1992.76.2.0191.

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✓ Brachial plexus palsy due to traction injury, especially spinal nerve-root avulsion, represents a severe handicap for the patient. Despite recent progress in diagnosis and microsurgical repair, the prognosis in such cases remains unfavorable. Nerve transfer is the only possibility for repair in cases of spinal nerve-root avulsion. This technique was analyzed in 37 patients with 64 reinnervation procedures of the musculocutaneous and/or axillary nerve using upper intercostal, spinal accessory, and regional nerves as donors. The most favorable results, with an 83.8% overall rate of useful functional recovery, were obtained in patients with upper brachial plexus palsy in which regional donor nerves, such as the medial pectoral, thoracodorsal, long thoracic, and subscapular nerves, had been used. The overall rates of recovery for the spinal accessory and upper intercostal nerves were 64.3% and 55.5%, respectively, which are significantly lower. The authors evaluate the results of nerve transfer and analyze different donor nerves as factors influencing the prognosis of surgical repair.

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Sulaiman, Olawale A. R., Daniel D. Kim, Clint Burkett, and David G. Kline. "NERVE TRANSFER SURGERY FOR ADULT BRACHIAL PLEXUS INJURY." Neurosurgery 65, suppl_4 (October 1, 2009): A55—A62. http://dx.doi.org/10.1227/01.neu.0000341165.83218.ac.

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Abstract OBJECTIVE To review the clinical outcomes in our patients who have undergone nerve transfer operations for brachial plexus reconstruction at the Louisiana State University (LSU) over a 10-year period. A secondary objective is to compare clinical outcomes in patients who had only nerve transfer operations as compared with patients whose nerve transfers were supplemented with direct repair of brachial plexus elements. METHODS Retrospective review of the medical records, imaging, and electrodiagnostic studies (electromyographic and nerve conduction studies) of patients with brachial plexus injuries who underwent nerve transfer operations at LSU over a period of 10 years. RESULTS A total of 81 patients were treated between 1995 to 2005 at the LSU Health Sciences Center; 7 of these patients were lost to follow-up, leaving 74 patients, with an average follow-up of 3.5 years, for review. We evaluated recovery of elbow flexion and shoulder abduction. Ninety percent of patients with medial pectoral to musculocutaneous nerve transfers recovered to LSU grade 2 (Medical Research Council grade 3), and 60% of those patients with intercostal to musculocutaneous nerve transfer regained similar strength in elbow flexion. Shoulder abduction recovery to LSU grade 2 (Medical Research Council grade 3) after spinal accessory to suprascapular and/or thoracodorsal to axillary nerve transfer, was 95% and 36%, respectively. There was a tendency for better motor recovery when nerve transfer operations were combined with direct repair of plexus elements. CONCLUSION Nerve transfers for repair of brachial plexus injuries result in excellent recovery of elbow and shoulder functions. Patients who had direct repair of brachial plexus elements in addition to nerve transfers tended to do better than those who had only nerve transfer operations.

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Isaacs, J., and A. R. Cochran. "Nerve transfers for peripheral nerve injury in the upper limb." Bone & Joint Journal 101-B, no. 2 (February 2019): 124–31. http://dx.doi.org/10.1302/0301-620x.101b2.bjj-2018-0839.r1.

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Nerve transfer has become a common and often effective reconstructive strategy for proximal and complex peripheral nerve injuries of the upper limb. This case-based discussion explores the principles and potential benefits of nerve transfer surgery and offers in-depth discussion of several established and valuable techniques including: motor transfer for elbow flexion after musculocutaneous nerve injury, deltoid reanimation for axillary nerve palsy, intrinsic re-innervation following proximal ulnar nerve repair, and critical sensory recovery despite non-reconstructable median nerve lesions.

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Cardoso, Marcio de Mendonça, Ricardo de Amoreira Gepp, Eduardo Mamare, and José Fernando Guedes-Correa. "Results of Phrenic Nerve Transfer to the Musculocutaneous Nerve Using Video-Assisted Thoracoscopy in Patients with Traumatic Brachial Plexus Injury: Series of 28 Cases." Operative Neurosurgery 17, no. 3 (December 28, 2018): 261–67. http://dx.doi.org/10.1093/ons/opy350.

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Abstract BACKGROUND The phrenic nerve can be transferred to the musculocutaneous nerve using video-assisted thoracoscopy, aiming at the recovery of elbow flexion in patients with traumatic brachial plexus injuries. There are few scientific papers in the literature that evaluate the results of this operative technique. OBJECTIVE To evaluate biceps strength and pulmonary function after the transfer of the phrenic nerve to the musculocutaneous nerve using video-assisted thoracoscopy. METHODS A retrospective study was carried out in a sample composed of 28 patients who were victims of traumatic injury to the brachial plexus from 2008 to 2013. Muscle strength was graded using the British Medical Research Council (BMRC) scale and pulmonary function through spirometry. Statistical tests, with significance level of 5%, were used. RESULTS In total, 74.1% of the patients had biceps strength greater than or equal to M3. All patients had a decrease in forced vital capacity and forced expiratory volume in 1 s, with no evidence of recovery over time. CONCLUSION Transferring the phrenic nerve to the musculocutaneous nerve using video-assisted thoracoscopy may lead to an increase in biceps strength to BMRC M3 or greater in most patients. Considering the deterioration in the parameters of spirometry observed in our patients and the future effects of aging in the respiratory system, it is not possible at the moment to guarantee the safety of this operative technique in the long term.

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Tung, Thomas H., Christine B. Novak, and Susan E. Mackinnon. "Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries." Journal of Neurosurgery 98, no. 2 (February 2003): 313–18. http://dx.doi.org/10.3171/jns.2003.98.2.0313.

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Object. In this study the authors evaluated the outcome in patients with brachial plexus injuries who underwent nerve transfers to the biceps and the brachialis branches of the musculocutaneous nerve. Methods. The charts of eight patients who underwent an ulnar nerve fascicle transfer to the biceps branch of the musculocutaneous nerve and a separate transfer to the brachialis branch were retrospectively reviewed. Outcome was assessed using the Medical Research Council (MRC) grade to classify elbow flexion strength in conjunction with electromyography (EMG). The mean patient age was 26.4 years (range 16–45 years) and the mean time from injury to surgery was 3.8 months (range 2.5–7.5 months). Recovery of elbow flexion was MRC Grade 4 in five patients, and Grade 4+ in three. Reinnervation of both the biceps and brachialis muscles was confirmed on EMG studies. Ulnar nerve function was not downgraded in any patient. Conclusions. The use of nerve transfers to reinnervate the biceps and brachialis muscle provides excellent elbow flexion strength in patients with brachial plexus nerve injuries.

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Ferris, Scott, and Isabella Reid. "Contemporary nerve reconstruction for iatrogenic musculocutaneous nerve injury after shoulder stabilization surgery." Journal of Shoulder and Elbow Surgery 29, no. 9 (September 2020): e341-e344. http://dx.doi.org/10.1016/j.jse.2020.03.025.

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Tung, Thomas H., Christine B. Novak, and Susan E. Mackinnon. "Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries." Neurosurgical Focus 16, no. 5 (May 2004): 313–18. http://dx.doi.org/10.3171/foc.2004.16.5.19.

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Object In this study the authors evaluated the outcome in patients with brachial plexus injuries who underwent nerve transfers to the biceps and the brachialis branches of the musculocutaneous nerve. Methods The charts of eight patients who underwent an ulnar nerve fascicle transfer to the biceps branch of the musculocutaneous nerve and a separate transfer to the brachialis branch were retrospectively reviewed. Outcome was assessed using the Medical Research Council (MRC) grade to classify elbow flexion strength in conjunction with electromyography (EMG). The mean patient age was 26.4 years (range 16–45 years) and the mean time from injury to surgery was 3.8 months (range 2.5–7.5 months). Recovery of elbow flexion was MRC Grade 4 in five patients, and Grade 4+in three. Reinnervation of both the biceps and brachialis muscles was confirmed on EMG studies. Ulnar nerve function was not downgraded in any patient. Conclusions The use of nerve transfers to reinnervate the biceps and brachialis muscle provides excellent elbow flexion strength in patients with brachial plexus nerve injuries.

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Tubbs, R. Shane, Charles A. Khoury, E. George Salter, Leslie Acakpo-Satchivi, John C. Wellons, Jeffrey P. Blount, and W. Jerry Oakes. "Quantitation of the lower subscapular nerve for potential use in neurotization procedures." Journal of Neurosurgery 105, no. 6 (December 2006): 881–83. http://dx.doi.org/10.3171/jns.2006.105.6.881.

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Object New information regarding nerve branches of the brachial plexus can be useful to the surgeon performing neurotization procedures following patient injury. Nerves in the vicinity of the axillae have been commonly used for neural grafting procedures, with the exception of the lower subscapular nerve (LSN). Methods The authors dissected and measured the LSN in 47 upper extremities (left and right sides) obtained in 27 adult cadavers, and determined distances between the LSN and surrounding nerves to help quantify it for possible use in neurotization procedures. The mean diameter of the LSN was 2.3 mm. The mean length of the LSN from its origin at the posterior cord until it branched to the subscapularis muscle was 3.5 cm, and the mean distance from this branch until its termination in the teres major muscle was 6 cm. Therefore, the mean length of the entire LSN from the posterior cord to the teres major was 9.5 cm. When the LSN was mobilized to explore its possible use in neurotization, it reached the entrance site of the musculocutaneous nerve into the coracobrachialis muscle in all but three sides and was within 1.5 cm from this point in these three. In the other specimens, the mean length of the LSN distal to this site of the musculocutaneous nerve was 2 cm. The mobilized LSN reached the axillary nerve trunk as it entered the quadrangular space in all specimens. The mean length of the LSN distal to this point on the axillary nerve was 2.5 cm. Furthermore, on all but one side the LSN was found within the confines of an anatomical triangle previously described by the authors. Conclusions The authors hope that these data will prove useful to the surgeon for both identifying the LSN and planning for potential neurotization procedures of the brachial plexus.

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Bertelli, Jayme Augusto, and Marcos Flávio Ghizoni. "Transfer of the Platysma Motor Branch to the Accessory Nerve in a Patient With Trapezius Muscle Palsy and Total Avulsion of the Brachial Plexus." Neurosurgery 68, no. 2 (February 1, 2011): E567—E570. http://dx.doi.org/10.1227/neu.0b013e318202086c.

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Abstract BACKGROUND AND IMPORTANCE: To report on the successful use of a platysma motor nerve transfer to the accessory nerve in a patient with concomitant trapezius and brachial plexus palsy. CLINICAL PRESENTATION: A 20-year-old man presented with total avulsion of the right brachial plexus combined with palsies of the accessory and phrenic nerve. The patient was operated on 4 months after his injury. The accessory nerve was repaired via direct transfer of the platysma motor branch. The contralateral C7 root was connected to the musculocutaneous nerve, and the hemihypoglossal nerve was grafted to the suprascapular nerve. Two intercostal nerves were attached to the triceps long head motor branch. CONCLUSION: Within 20 months of surgery, the patient regained full reinnervation of the upper trapezius muscle. Elbow flexion scored M3+, and 30° active shoulder abduction was observed. Triceps reinnervation was poor. Platysma motor branch transfer to the accessory nerve is a viable alternative to reinnervate the trapezius muscle.

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Rodrigues, Flávio Freinkel, Maurício Moscovici, and Mendel Suchmacher. "Brachial Plexus Neurotization Through Accessory Nerve (Spinal Branch)-musculocutaneous Nerve Anastomosis." Neurosurgery Quarterly 19, no. 4 (December 2009): 219–21. http://dx.doi.org/10.1097/wnq.0b013e3181b0cb2b.

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Carlstedt, Thomas, V. Peter Misra, Anastasia Papadaki, Donald McRobbie, and Praveen Anand. "Return of spinal reflex after spinal cord surgery for brachial plexus avulsion injury." Journal of Neurosurgery 116, no. 2 (February 2012): 414–17. http://dx.doi.org/10.3171/2011.7.jns111106.

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Motor but not sensory function has been described after spinal cord surgery in patients with brachial plexus avulsion injury. In the featured case, motor-related nerve roots as well as sensory spinal nerves distal to the dorsal root ganglion were reconnected to neurons in the ventral and dorsal horns of the spinal cord by implanting nerve grafts. Peripheral and sensory functions were assessed 10 years after an accident and subsequent spinal cord surgery. The biceps stretch reflex could be elicited, and electrophysiological testing demonstrated a Hoffman reflex, or Hreflex, in the biceps muscle when the musculocutaneous nerve was stimulated. Functional MR imaging demonstrated sensory motor cortex activities on active as well as passive elbow flexion. Quantitative sensory testing and contact heat evoked potential stimulation did not detect any cutaneous sensory function, however. To the best of the authors' knowledge, this case represents the first time that spinal cord surgery could restore not only motor function but also proprioception completing a spinal reflex arch.

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Bertelli, Jayme Augusto, Jean Claude Mira, Monique Pecot-Dechavassine, and Alain Sebille. "Selective motor hyperreinnervation using motor rootlet transfer: an experimental study in rat brachial plexus." Journal of Neurosurgery 87, no. 1 (July 1997): 79–84. http://dx.doi.org/10.3171/jns.1997.87.1.0079.

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✓ Misdirection of sensory fibers into motor pathways is, in part, responsible for the poor results obtained after peripheral nerve repair. After avulsion of the C-5 root in rats, the authors connected a C-4 ventral rootlet to the musculocutaneous nerve by means of a sural nerve graft. In this way, they were able to increase the number of regenerating motor fibers and avoid growth of sensory fibers into the nerve grafts. Functional recovery was evaluated electrophysiologically and histologically. The origin of the axons that reinnervated the nerve graft was analyzed by means of morphological studies including retrograde labeling procedures. Motor neurons survived and regenerated after the rootlet transfer and there was no functional impairment. Many neurons were retrograde labeled in the ventral horn and widespread biceps muscle reinnervation was demonstrated with recovery of nearly normal electrophysiological properties. Motor hyperreinnervation of the musculocutaneous nerve was observed. This high degree of reinnervation in a long (40-mm) graft was attributed to the good chance that a muscle fiber can be reinnervated by a motor fiber when the number of regenerating motor neurons is increased and when competitive sensory fibers are excluded from reinnervation.

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Tamura, Y., G. Inoue, and R. Nakamura. "Intercostal Nerve Transfer to the Musculocutaneous Nerve in Avulsed Brachial Plexus Injuries." Journal of Hand Surgery 19, no. 1_suppl (February 1994): 19. http://dx.doi.org/10.1016/0266-7681(94)90321-2.

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de Moura, Wilson. "Surgical Anatomy of the Musculocutaneous Nerve: A Photographic Essay." Journal of Reconstructive Microsurgery 1, no. 04 (July 1985): 291–97. http://dx.doi.org/10.1055/s-2007-1007088.

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Lin, Haodong, Duanqing Lv, Chunlin Hou, and Desong Chen. "Modified C-7 neurotization in the treatment of brachial plexus avulsion injury." Journal of Neurosurgery 115, no. 4 (October 2011): 865–69. http://dx.doi.org/10.3171/2011.6.jns101604.

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Object Contralateral C-7 transfer is often used in patients with brachial plexus avulsion injury. Traditionally, the contralateral C-7 root has only been transferred to a single nerve, such as the median or radial nerve. In this study, the authors aimed to evaluate the efficacy of contralateral C-7 transfer to 2 different recipient nerves in patients with brachial plexus avulsion injuries. Methods Between 2004 and 2008, 10 patients with brachial plexus root avulsions underwent nerve reconstruction using a modified C-7 neurotization technique. In this procedure, the contralateral C-7 root was transferred via vascularized ulnar nerve grafts to both the musculocutaneous nerve and the median nerve on the affected side. Results The strength of the biceps muscles increased to M3 or M4 in 6 patients and to M2 in 2 patients. The median nerve transfers led to regained motor function and strength of the wrist and finger flexors with improvement to M3 in 5 patients. Seven patients showed notable gains of sensory function (≥ S3). Conclusions Contralateral C-7 transfer to 2 different recipient nerves is a feasible and efficient approach in patients with brachial plexus avulsion injuries when the donor nerve is limited.

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Ferraresi, Stefano, Debora Garozzo, Roberta Ravenni, Rinaldo Dainese, Domenico De Grandis, and Paolo Buffatti. "Hemihypoglossal Nerve Transfer in Brachial Plexus Repair: Technique and Results." Neurosurgery 50, no. 2 (February 1, 2002): 332–35. http://dx.doi.org/10.1097/00006123-200202000-00016.

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ABSTRACT OBJECTIVE In multiple avulsions of the brachial plexus, the search for extraplexal donor nerves in the hope of achieving motor neurotization is a major goal. We explored the possibility of using the hypoglossal nerve as a transfer point to reanimate muscles in the upper limb. METHODS The hypoglossal nerve was used as a donor nerve for neurotization in seven patients with avulsive injuries of the brachial plexus. The surgical technique—an end-to-side microsuture using approximately half of the nerve fascicles—is basically the same as that used in the hypoglossal nerve-facial nerve jump graft, which is a well-known technique in facial nerve reanimation. The recipient nerves were the suprascapular (two patients), the musculocutaneous (one patient), the posterior division of the upper trunk (two patients), and the medial contribution to the median nerve (two patients). RESULTS In spite of a connection documented by electromyography and selective activation in three of seven patients, the functional results in our patients were extremely disappointing: no patient had an outcome better than M1 in the reinnervated muscles. CONCLUSION This technique was of no help to the patients and thus has been abandoned at our institution.

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Pan, Woei-Jack, Yee-Sze Teo, Haw-Chong Chang, Kian-Chun Chong, and Sarina Abdul Karim. "The Relationship of the Lateral Cord of the Brachial Plexus to the Coracoid Process during Arthroscopic Coracoid Surgery." American Journal of Sports Medicine 36, no. 10 (June 16, 2008): 1998–2001. http://dx.doi.org/10.1177/0363546508317719.

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Background Arthroscopic coracoid decompression is performed for coracoid impingement and has also been advocated for arthroscopic repair of tears of the subscapularis tendon, placing the lateral cord or the musculocutaneous nerve at risk of injury. The dynamic relationship of the lateral cord to the coracoid while the upper limb is in abduction and traction in the shoulder arthroscopy position is not clear. Purpose The purpose of this study was to evaluate the dynamic relationship of the lateral cord of the brachial plexus to the coracoid process during varying degrees of upper limb abduction in traction. Study Design Descriptive laboratory study. Methods and Materials The musculocutaneous nerves of 15 fresh-frozen cadaveric shoulders were carefully dissected and identified without mobilization of the nerve. The musculocutaneous nerve was then injected with radiopaque contrast mixed with methylene blue. The contrast would infiltrate retrogradely into the lateral cord, minimizing mobilization of the lateral cord. The specimens were mounted in the lateral decubitus position with 4.5 kg of traction to the forearm and anteroposterior radiographs were taken at 30° and 60° of abduction. The nearest distance of the lateral cord to the coracoid process was measured off the radiographs and the displacement with increase in shoulder abduction was determined. Results The mean nearest distance between the lateral cord and the coracoid tip at 30° of shoulder abduction was 26.6 ± 5.2 mm and it moved nearer at 60° of abduction to 23.4 ± 5.1 mm; the difference of 3.2 mm was statistically significant ( P < .0005, 95% confidence interval, 2.5–3.9 mm). The shortest distance measured was 14.4 mm in 1 specimen at 60° of abduction. Conclusion The lateral cord moved closer to the coracoid process at 60° than at 30° of abduction under traction during simulated shoulder arthroscopy position using the lateral decubitus position. Clinical Relevance The margin of safety for lateral cord injury during arthroscopic surgery around the coracoid process is improved with lower abduction angles in the lateral decubitus position.

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Roganovic, Zoran, and Goran Pavlicevic. "Difference in Recovery Potential of Peripheral Nerves after Graft Repairs." Neurosurgery 59, no. 3 (September 1, 2006): 621–33. http://dx.doi.org/10.1227/01.neu.0000228869.48866.bd.

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Abstract OBJECTIVE: To our knowledge, few studies have been published regarding differences in nerve recovery potentials. In this study, sensory and motor recovery potentials were compared between different nerves. METHODS: A prospective study of a homogenous group of 393 graft repairs of the median, ulnar, radial, tibial, peroneal, femoral, and musculocutaneous nerves, with the scoring of motor and sensory recoveries. Sensory and motor recovery potentials, defined on the basis of average scores and rates of useful recovery, were compared between the different nerves, and separately for high-, intermediate-, and low-level repairs. RESULTS: Sensory recovery potential was similar for all nerves tested (P > 0.05), but motor recovery potential differed significantly. After high-level repairs, motor recovery potential was significantly better for the radial and tibial nerves (useful recovery in 66.7 and 54.5% of patients, respectively), than for the ulnar and peroneal nerves (useful recovery in 15.4 and 13.8% of patients, respectively; P < 0.05). After intermediate-level repairs, motor recovery potential was better for the musculocutaneous, radial, and femoral nerves (useful recovery in 100, 98.3, and 87.5% of repairs, respectively), than for the tibial, median and ulnar nerves (useful recovery in 63.9, 52, and 43.6% of repairs, respectively; P < 0.05). In addition, motor recovery potential was significantly the worst with peroneal nerve repairs (useful recovery in 15.2% of patients; P < 0.05). After low-level repairs, motor recovery potential was similar for all nerves (useful recovery in the range of 88.9–100% of patients and in 56.3% of peroneal nerve repairs). CONCLUSION: Sensory recovery potential is similar for the median, ulnar, and tibial nerves. The expression of motor recovery potential depends on the repair level. With low- and high-level repairs, it does not stand out in an obvious way, but it is fully expressed with intermediate-level repairs, classifying nerves into three categories with excellent, moderate, and poor recovery potential.

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Sinha, Sumit, G. Lakshmi Prasad, and Sanjeev Lalwani. "A cadaveric microanatomical study of the fascicular topography of the brachial plexus." Journal of Neurosurgery 125, no. 2 (August 2016): 355–62. http://dx.doi.org/10.3171/2015.6.jns142181.

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OBJECT Mapping of the fascicular anatomy of the brachial plexus could provide the nerve surgeon with knowledge of fascicular orientation in spinal nerves of the brachial plexus. This knowledge might improve the surgical outcome of nerve grafting in brachial plexus injuries by anastomosing related fascicles and avoiding possible axonal misrouting. The objective of this study was to map the fascicular topography in the spinal nerves of the brachial plexus. METHODS The entire right-sided brachial plexus of 25 adult male cadavers was dissected, including all 5 spinal nerves (C5–T1), from approximately 5 mm distal to their exit from the intervertebral foramina, to proximal 1 cm of distal branches. All spinal nerves were tagged on the cranial aspect of their circumference using 10-0 nylon suture for orientation. The fascicular dissection of the C5–T1 spinal nerves was performed under microscopic magnification. The area occupied by different nerve fascicles was then expressed as a percentage of the total cross-sectional area of a spinal nerve. RESULTS The localization of fascicular groups was fairly consistent in all spinal nerves. Overall, 4% of the plexus supplies the suprascapular nerve, 31% supplies the medial cord (comprising the ulnar nerve and medial root of the median nerve [MN]), 27.2% supplies the lateral cord (comprising the musculocutaneous nerve and lateral root of the MN), and 37.8% supplies the posterior cord (comprising the axillary and radial nerves). CONCLUSIONS The fascicular dissection and definitive anatomical localization of fascicular groups is feasible in plexal spinal nerves. The knowledge of exact fascicular location might be translatable to the operating room and can be used to anastomose related fascicles in brachial plexus surgery, thereby avoiding the possibility of axonal misrouting and improving the results of plexal reconstruction.

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Journal articles on the topic 'Musculocutaneous nerve Surgery'

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