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What is the Most Optimal Nerve Transfer for Brachial Plexus Patients?

Phoenix, AZ—January 11, 2018

After an upper brachial plexus injury (BPI), a surgeon typically performs reconstructive surgery to restore nerve supply for elbow flexion.

While there are multiple techniques to achieve this, there are no recent studies that analyze which is optimal for patients to regain elbow flexion. Researchers from Hospital for Special Surgery set out to determine the best method to improve elbow flexion strength after BPI.

The study looked at data from 12 patients who underwent a nerve transfer for elbow flexion reconstruction after a BPI. The data was collected between 2005 and 2013 and includes physical examination and electromyographic (EMG) data.  There were no demographic differences between the patients.

The researchers found that the ulnar fascicular nerve transfer to brachialis and median fascicular nerve transfer to biceps brachii motor branch appeared to have more advantages when compared to an ulnar fascicular nerve transfer to biceps brachii and median fascicular nerve transfer to brachialis motor branch. After this method, patients saw a British Medical Research Score (BMRC) grade 4 elbow flexion strength earlier than expected, as well as increased motor unit recruitment of the brachialis muscle EMG. Elbow flexion strength did eventually equalize at 36 months regardless of surgical technique.

With a lack of available literature on this specialized injury, this study provides valuable insight to surgeons who had no prior indication of the most optimal nerve transfer for their patients.

Abstract Title: Elbow Flexion Restoration in Brachial Plexus Injuries: What is the Optimal Nerve Transfer?

Authors: Natalia Fullerton, MD; Eliana Saltzman, MD; Joseph T. Nguyen, MPH; Anum Lalani, MPH; Steve K. Lee, MD; Scott W. Wolfe, MD


About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the eighth consecutive year) and No. 3 in rheumatology by U.S. News & World Report (2017-2018). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients from 80 countries and performed more than 32,000 surgical procedures. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Innovation Institute was formed in 2015 to realize the potential of new drugs, therapeutics and devices; the global standard total knee replacement was developed at HSS in 1969, and in 2017 HSS made 130 invention submissions (more than 2x the submissions in 2015). The HSS Education Institute provides continuing medical curriculum to more than 22,000 subscribing musculoskeletal healthcare professionals in 125 countries. Through HSS Global, the institution is collaborating with medical centers worldwide to advance the quality and value of care and to make world-class HSS care more accessible to more people.


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