Patient Outcome Following A Nerve Transfer To The Musculocutaneous Nerve Using Fascicles Of The Ulnar Nerve For Reconstruction Of Elbow Flexion In C5-C7Brachial Plexus Root Avulsion Injury

Introduction:Adult brachial plexus injuries were a kind of severe functional compromised injuries, especially got worse prognosis in the root avulsion injury. The devastating outcomes include movement disability, sensation loss, psychological disorder and apparent changes. It is acknowledged that elbow flexion is prior to any other functions to recover. Oberlin et. recovered the elbow flexion using branches to FCU of the ulnar nerve as donor nerve transfer to the branches to biceps of the musculocutaneous nerve in4cases of upper brachial plexus palsy with a85%clinical efficiency. Although other foreign authors published the same case reports with satisfied results latterly, we still have not enough such following up reports in our contry.Obective:To observe the long-term patient outcome using a nerve transfer to the musculocutaneous nerve using fascicles of the ulnar nerve for reconstruction of elbow flexion in C5-C6and C5-C7brachial plexus root avulsion injury.Method:From2005January to2008December, we collected7patient with C5-C6and C5-C7brachial plexus root avulsion injuries. All patients were male.2cases were affected in C5-C6roots,5were affected in C5-C7roots. The ages ranged from30years old to58years old,39.6averagely. The follow-up time ranged from32months to75months,49.3averagely. The average time between injury and operation was10.9months, ranged from1month to22months. The patients were evaluated with regard to reinnervation of the biceps, ulnar nerve function, elbow flexion strength, and grip strength.Results:3patients achieved good results (grade-4strength or better),2patients achieved fair results (grade-3strength),2patients achieved poor results (grade-2strength or worse). Five patients finally achieve grade-3strength or better strength, the efficiency of this procedure is about71.4%. The activity ROM of elbow flexion is120°to150°in patients with good results and fair results. All the C5-C6root avulsion cases achieved fair results,3achieved good results and2poor results respectively in the C5-C7root avulsion cases. The average time required for reinnervation of the biceps after nerve fascicle transfer was4.7months (ranged from3months to7 months). The average time for achievement of biceps grade-3strength after nerve transfer was6.9months (ranged from4.5months to9months). No motor or sensory deficits related to the ulnar nerve were noted clinically.Conclusion:According to the limited cases, we could assume that nerve transfer to the musculocutaneous nerve using fascicles of the ulnar nerve for reconstruction of elbow flexion in C5-C6and C5-C7brachial plexus avulsion injury is a safety and efficient procedure.