The recent use of nerve transfers presents a paradigm shift in the management of nerve injury. Surgical reconstruction of proximal level nerve injures or repairs with long nerve grafts often result in less than optimal outcomes, thus presenting the opportunity for other reconstructive techniques. Nerve transfers provide a closer source of axons to the motor end plates from an uninjured nerve to a recipient nerve and in many cases these transfers eliminate the need for a nerve graft by allowing a direct end to end nerve repair without tension. Basic research on cortical plasticity, peripheral nerve regeneration and muscle recovery support the concept that transfer is by far the best method of nerve reconstruction when ever possible. This edition of Clinics will review the surgical options and experiences of experts in the field using nerve transfers for patients with upper extremity nerve injuries.
Author(s): Susan E. Mackinnon, Christine B. Novak
Series: The Clinics: Orthopedics
Edition: 1
Publisher: Saunders
Year: 2008
Language: English
Commentary: 18611
Pages: 176
Nerve Transfers, Hand Clinics, Volume 24, Issue 4, Pages 319-488 (November 2008)......Page 1
Contents......Page 2
Forthcoming Issues......Page 5
Dedication......Page 6
Postdoctoral research fellows......Page 7
References......Page 8
Preface......Page 9
Treatment of Thumb Metacarpophalangeal and Interphalangeal Joint Arthritis......Page 10
Nerve Transfers in the Forearm and Hand......Page 11
The median to radial transfer: technique......Page 12
Restoration of sensation to the radial sensory nerve distribution......Page 14
Median nerve deficit......Page 15
Thumb opposition......Page 16
Anterior interosseous nerve to median recurrent motor branch transfer: technique......Page 18
Intramedian nerve transfer for sensory loss caused by upper plexus injury: technique......Page 19
Flexion and pronation......Page 20
Nerve transfer for restoration of anterior interosseous nerve function: technique......Page 21
Nerve transfer for restoration of pronator teres function: technique......Page 23
Nerve transfer for restoration of anterior interosseous nerve function using the brachialis branch of the musculocutaneous nerve: technique......Page 24
Transfer of the distal anterior interosseous nerve tonbspthe ulnar deep motor branch: technique......Page 26
Nerve transfers to restore ulnar sensation: technique......Page 27
Postoperative care......Page 28
Summary......Page 29
References......Page 30
Distal spinal accessory to suprascapular nerve transfer......Page 33
Physical examination......Page 35
Objective studies......Page 38
Indications......Page 39
Upper brachial plexus injury......Page 40
Double nerve transfer for shoulder function......Page 41
Medial triceps nerve to axillary nerve transfer......Page 43
Double fascicular transfer for elbow function......Page 44
Medial pectoral nerve......Page 45
Thoracodorsal nerve......Page 46
Intercostal nerves......Page 47
Total brachial plexus injury......Page 48
Summary......Page 50
References......Page 51
Evaluation......Page 54
Consideration factors for nerve transfers......Page 55
Selection of the donor nerve......Page 57
Selection of the recipient nerve......Page 58
Suprascapular nerve transfer......Page 59
Radial nerve transfer......Page 60
Other donors......Page 61
Ulnar nerve transfer......Page 62
Median nerve transfer......Page 63
Intercostal nerve transfer......Page 64
Outcomes of nerve transfers......Page 65
References......Page 66
Intraplexus nerve transfer with functioning free muscle transplantation......Page 68
Nerve transfer with functioning free muscle transplantation......Page 69
General principles for nerve transfer with functioning free muscle transplantation......Page 70
Functioning free muscle transplantation for elbow flexion using intercostal nerve transfer......Page 72
Functioning free muscle transplantation for elbow extension using phrenic nerve transfer in one stage, or using proximal nerve transfer in a two-stage procedure......Page 73
Close-target nerve transfer with functioning free muscle transplantation......Page 74
End-to-side neurorrhaphy nerve transfer......Page 75
Postoperative management and rehabilitation......Page 76
Acknowledgments......Page 78
References......Page 79
Contralateral C7 Transfer in Adult Plexopathies......Page 80
Intraoperative findings of the involved brachial plexus......Page 81
Surgical technique......Page 82
Reconstruction methods......Page 83
Results......Page 85
Discussion......Page 86
References......Page 90
British Medical Research Council muscle grading......Page 92
Factors affecting outcome......Page 93
The ideal outcome measures......Page 94
Measurement of muscle motor function......Page 95
Measurement of motion......Page 96
Sensation and sensibility......Page 98
Patient-related outcomes: disability of the arm, shoulder and hand......Page 99
Biomechanical evaluation......Page 100
Opportunities for the future......Page 102
References......Page 103
Early phase rehabilitation......Page 107
Late phase rehabilitation......Page 108
Summary......Page 111
References......Page 112
Cortical Plasticity Following Nerve Transfer in the Upper Extremity......Page 114
Structural MRI......Page 115
Functional MRI......Page 116
Transcranial magnetic stimulation......Page 117
Cortical plasticity following amputation......Page 118
Cortical plasticity following intercostal nerve transfers......Page 119
Cortical plasticity following ICN-MCN transfer......Page 123
Cortical plasticity following contralateral C7 nerve transfer......Page 125
Motor relearning following nerve transfer......Page 126
Summary......Page 128
References......Page 129
Sequelae of denervation......Page 134
Process of reinnervation and recovery......Page 137
Rapid versus delayed reinnervation......Page 138
Electrical stimulation......Page 139
Summary......Page 140
References......Page 141
End-to-Side Nerve Repair: Review of the Literature and Clinical Indications......Page 144
Sensory versus motor regeneration after end-to-side repair......Page 145
References......Page 147
Hand function in the uninjured baboon with attention to opposition of the thumb......Page 150
Does end-to-side coaptation exist and does it provide useful recovery?......Page 151
Origin of the sprouts......Page 152
Early personal clinical experience......Page 155
Case report 1......Page 156
Case report 2......Page 157
Case report 4......Page 159
Experimental study on synergistic nerve fiber transfer by terminal end-to-side coaptation......Page 162
Material and methods......Page 163
Results......Page 166
Compound nerve action potential area......Page 167
Correlation length of nerve graft-wet and dry thenar muscle weight......Page 168
Neurofilament antibodies used to stain axons-number of neurofilaments positive axon 3 months after surgery......Page 169
Clinical application of synergistic nerve fiber transfer by end-to-side coaptation......Page 170
Discussion and future outlook......Page 171
References......Page 172
Index......Page 173
