title: Transfer of the radial nerve branch to the extensor carpi radialis brevis to the anterior interosseous nerve to reconstruct thumb and finger flexion.
abstract: OBJECTIVE
  To report our experiences reconstructing thumb and finger flexion in patients with extensive palsy of the upper limb by transferring the radial nerve branch to the extensor carpi radialis brevis (ECRB) to the anterior interosseous nerve (AIN).
  
  
  METHODS
  Within 8 months after injury, 4 patients with either a combined high median/ulnar nerve palsy or C7-T1 brachial plexus root avulsion underwent surgical reconstruction for thumb and finger flexion. As part of the reconstructive procedure, the branch of the radial nerve to the ECRB was transferred to the AIN.
  
  
  RESULTS
  At final evaluation, which averaged 13 months postoperatively, all patients had recovered full finger and thumb flexion, scoring M4 per Medical Research Council guidelines. Average grasp strength was 5 kg, and pinch strength was 2 kg. Even in anesthetic fingers and with their eyes closed, patients could correctly identify passive extension of their distal interphalangeal joints. Wrist extension was preserved in all patients.
  
  
  CONCLUSIONS
  In 4 patients, transfer of the branch of the radial nerve to the ECRB to the AIN predictably reconstructed thumb and finger flexion. Finger flexion also recovered in those fingers in which the flexor digitorum profundus was primarily innervated by the ulnar nerve. Despite extended sensory deficits, patients ultimately were able to use their hands regularly in daily life.
  
  
  METHODS
  Therapeutic III.
authors.affiliation: Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Brazil; Governador Celso Ramos Hospital, Department of Orthopedic Surgery, Florianópolis, Brazil. Electronic address: drbertelli@gmail.com.
authors.forename: Jayme Augusto
authors.initials: JA
authors.lastname: Bertelli
mesh_terms: D000293:Adolescent; D000328:Adult; D001917:Brachial Plexus / Q000293:injuries* / Q000503:physiopathology*; D005260:Female; D005385:Fingers / Q000294:innervation*; D006801:Humans; D008297:Male; D020423:Median Neuropathy / Q000503:physiopathology* / Q000601:surgery*; D009048:Motor Skills / Q000502:physiology; D009416:Nerve Regeneration / Q000502:physiology; D016067:Nerve Transfer / Q000379:methods*; D010147:Pain Measurement; D010525:Peripheral Nerves / Q000601:surgery*; D011434:Proprioception / Q000502:physiology; D011826:Radial Nerve / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology*; D012684:Sensory Thresholds / Q000502:physiology; D013933:Thumb / Q000294:innervation*; D020424:Ulnar Neuropathies / Q000503:physiopathology* / Q000601:surgery*; D055815:Young Adult
keywords: Nerve transfer; finger flexion reconstruction; high median nerve palsy; high ulnar nerve palsy