title: Nerve transfers for elbow and finger extension reconstruction in midcervical spinal cord injuries.
abstract: OBJECTIVE
  The objective of this study was to report the results of elbow, thumb, and finger extension reconstruction via nerve transfer in midcervical spinal cord injuries.
  
  
  METHODS
  Thirteen upper limbs from 7 patients with tetraplegia, with an average age of 26 years, were operated on an average of 7 months after a spinal cord injury. The posterior division of the axillary nerve was used to reinnervate the triceps long and upper medial head motor branches in 9 upper limbs. Both the posterior division and the branch to the middle deltoid were used in 2 upper limbs, and the anterior division of the axillary nerve in the final 2 limbs. For thumb and finger extension reconstruction, the nerve to the supinator was transferred to the posterior interosseous nerve.
  
  
  RESULTS
  In 22 of the 27 recipient nerves, a peripheral type of palsy with muscle denervation was identified. At an average of 19 months follow-up, elbow strength scored M4 in 11 upper limbs and M3 in 2, according to the British Medical Research Council scale. Thumb extension scored M4 in 8 upper limbs and scored M3 in 4. Finger extension scored M4 in 12 hands. No donor-site deficits were reported or observed.
  
  
  CONCLUSIONS
  Nerve transfers are effective at restoring elbow, thumb, and finger extension in patients with a midcervical spinal cord injury, which occurs in the majority of patients with a peripheral type of palsy with muscle denervation in their upper limbs. Efforts should be made to perform operations in these patients within 12 months of injury.
authors.affiliation: Department of Neurosurgery, University of the South of Santa Catarina (UNISUL), Tubarão, Brazil.
authors.forename: Jayme Augusto
authors.initials: JA
authors.lastname: Bertelli
authors.forename: Marcos Flávio
authors.initials: MF
authors.lastname: Ghizoni
mesh_terms: D000328:Adult; D001365:Axilla / Q000294:innervation / Q000601:surgery; D002574:Cervical Vertebrae / Q000293:injuries*; D057645:Deltoid Muscle / Q000294:innervation / Q000601:surgery; D004550:Elbow / Q000294:innervation / Q000601:surgery*; D005260:Female; D005385:Fingers / Q000294:innervation / Q000601:surgery*; D006801:Humans; D008297:Male; D009417:Nerve Tissue / Q000637:transplantation*; D011782:Quadriplegia / Q000209:etiology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D013119:Spinal Cord Injuries / Q000601:surgery*; D013933:Thumb / Q000294:innervation / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: BMRC = British Medical Research Council; axillary nerve; elbow extension; nerve transfer; neurotization; peripheral nerve; tetraplegia