title: Results of wrist extension reconstruction in C5-8 brachial plexus palsy by transferring the pronator quadratus motor branch to the extensor carpi radialis brevis muscle.
abstract: OBJECT The objective of this study was to report the results of pronator quadratus (PQ) motor branch transfers to the extensor carpi radialis brevis (ECRB) motor branch to reconstruct wrist extension in C5-8 root lesions of the brachial plexus. METHODS Twenty-eight patients, averaging 24 years of age, with C5-8 root injuries underwent operations an average of 7 months after their accident. In 19 patients, wrist extension was impossible at baseline, whereas in 9 patients wrist extension was managed by activating thumb and wrist extensors. When these 9 patients grasped an object, their wrist dropped and grasp strength was lost. Wrist extension was reconstructed by transferring the PQ motor to the ECRB motor branch. After surgery, patients were followed for at least 12 months, with final follow-up an average of 22 months after surgery. RESULTS Successful reinnervation of the ECRB was demonstrated in 27 of the 28 patients. In 25 of the patients, wrist extension scored M4, and in 2 it scored M3. CONCLUSIONS In C5-8 root injuries, wrist extension can be predictably reconstructed by transferring the PQ motor branch to reinnervate the ECRB.
authors.affiliation: Department of Neurosurgery, Southern University of Santa Catarina (UNISUL), Tubarão; and.|Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil.
authors.forename: Jayme Augusto
authors.initials: JA
authors.lastname: Bertelli
authors.affiliation: Department of Neurosurgery, Southern University of Santa Catarina (UNISUL), Tubarão; and.
authors.forename: Marcos Flávio
authors.initials: MF
authors.lastname: Ghizoni
authors.affiliation: Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil.
authors.forename: Cristiano Paulo
authors.initials: CP
authors.lastname: Tacca
mesh_terms: D000328:Adult; D001917:Brachial Plexus / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000294:innervation*; D016067:Nerve Transfer / Q000379:methods*; D010525:Peripheral Nerves / Q000637:transplantation*; D016059:Range of Motion, Articular / Q000502:physiology*; D014953:Wrist / Q000294:innervation*
keywords: AIN = anterior interosseous nerve; ECRB = extensor carpi radialis brevis; FCU = flexor carpi ulnaris; FDP = flexor digitorum profundus; FDS = flexor digitorum superficialis; FPL = flexor pollicis longus; MRC = Medical Research Council; PQ = pronator quadratus; PT = pronator teres; brachial plexus; nerve grafting; nerve transfer; neurotization; peripheral nerve; wrist extension