title: Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Tung
authors.forename: Christine B
authors.initials: CB
authors.lastname: Novak
authors.forename: Susan E
authors.initials: SE
authors.lastname: Mackinnon
mesh_terms: D000293:Adolescent; D000328:Adult; D001917:Brachial Plexus / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000503:physiopathology* / Q000601:surgery*; D004550:Elbow / Q000503:physiopathology*; D004576:Electromyography; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology* / Q000601:surgery*; D009138:Musculocutaneous Nerve / Q000503:physiopathology* / Q000601:surgery*; D016067:Nerve Transfer; D017063:Outcome Assessment, Health Care; D018583:Pliability; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D013997:Time Factors; D014459:Ulnar Nerve / Q000503:physiopathology* / Q000601:surgery*