title: Comparative study of phrenic and intercostal nerve transfers for elbow flexion after global brachial plexus injury.
abstract: BACKGROUND
  Global brachial plexus injuries (BPIs) are devastating events frequently resulting in severe functional impairment. The widely used nerve transfer sources for elbow flexion in patients with global BPIs include intercostal and phrenic nerves.
  
  
  OBJECTIVE
  The aim of this study was to compare phrenic and intercostal nerve transfers for elbow flexion after global BPI.
  
  
  METHODS
  A retrospective review of 33 patients treated with phrenic and intercostal nerve transfer for elbow flexion in posttraumatic global root avulsion BPI was carried out. In the phrenic nerve transfer group, the phrenic nerve was transferred to the anterolateral bundle of the anterior division of the upper trunk (23 patients); in the intercostal nerve transfer group, three intercostal nerves were coapted to the anterolateral bundles of the musculocutaneous nerve. The British Medical Research Council (MRC) grading system, angle of elbow flexion, and electromyography (EMG) were used to evaluate the recovery of elbow flexion at least 3 years postoperatively.
  
  
  RESULTS
  The efficiency of motor function in the phrenic nerve transfer group was 83%, while it was 70% in the intercostal nerve transfer group. The two groups were not statistically different in terms of the MRC grade (p=0.646) and EMG results (p=0.646). The outstanding rates of angle of elbow flexion were 48% and 40% in the phrenic and intercostal nerve transfer groups, respectively. There was no significant difference of outstanding rates in the angle of elbow flexion between the two groups.
  
  
  CONCLUSIONS
  Phrenic nerve transfer had a higher proportion of good prognosis for elbow flexion than intercostal nerve transfer, but the effective and outstanding rate had no significant difference for biceps reinnervation between the two groups according to MRC grading, angle of elbow flexion, and EMG.
authors.affiliation: Department of Hand Surgery, Shanghai Huashan Hospital, 12 Wulumuqi Zhong Road, Jing An District, Shanghai 200040, China.
authors.forename: Yuzhou
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Hand Surgery, Shanghai Huashan Hospital, 12 Wulumuqi Zhong Road, Jing An District, Shanghai 200040, China. Electronic address: lyz41_2000@sina.com.
authors.forename: Jie
authors.initials: J
authors.lastname: Lao
authors.affiliation: Department of Hand Surgery, Shanghai Huashan Hospital, 12 Wulumuqi Zhong Road, Jing An District, Shanghai 200040, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D000328:Adult; D001917:Brachial Plexus / Q000293:injuries* / Q000601:surgery; D020516:Brachial Plexus Neuropathies / Q000503:physiopathology / Q000601:surgery*; D004551:Elbow Joint / Q000294:innervation / Q000601:surgery*; D005260:Female; D006801:Humans; D007367:Intercostal Nerves / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D016067:Nerve Transfer; D010791:Phrenic Nerve / Q000637:transplantation*; D026741:Physical Therapy Modalities; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D004561:Transcutaneous Electric Nerve Stimulation; D016896:Treatment Outcome
keywords: Elbow flexion; Global brachial plexus injury; Intercostal nerve; Phrenic nerve