title: Results of nerve grafting in radial nerve injuries occurring proximal to the humerus, including those within the posterior cord.
abstract: OBJECTIVE Results of radial nerve grafting are largely unknown for lesions of the radial nerve that occur proximal to the humerus, including those within the posterior cord. METHODS The authors describe 13 patients with proximal radial nerve injuries who were surgically treated and then followed for at least 24 months. The patients' average age was 26 years and the average time between accident and surgery was 6 months. Sural nerve graft length averaged 12 cm. Recovery was scored according to the British Medical Research Council (BMRC) scale, which ranges from M0 to M5 (normal muscle strength). RESULTS After grafting, all 7 patients with an elbow extension palsy recovered elbow extension, scoring M4. Six of the 13 recovered M4 wrist extension, 6 had M3, and 1 had M2. Thumb and finger extension was scored M4 in 3 patients, M3 in 2, M2 in 2, and M0 in 6. CONCLUSIONS The authors consider levels of strength of M4 for elbow and wrist extension and M3 for thumb and finger extension to be good results. Based on these criteria, overall good results were obtained in only 5 of the 13 patients. In proximal radial nerve lesions, the authors now advocate combining nerve grafts with nerve or tendon transfers to reconstruct wrist, thumb, and finger extension.
authors.affiliation: Department of Neurosurgery, Southern University of Santa Catarina [Unisul], Avenida José Acácio Moreira, Tubarão, Brazil.
authors.forename: Jayme Augusto
authors.initials: JA
authors.lastname: Bertelli
authors.affiliation: Department of Neurosurgery, Southern University of Santa Catarina [Unisul], Avenida José Acácio Moreira, Tubarão, Brazil.
authors.forename: Marcos Flávio
authors.initials: MF
authors.lastname: Ghizoni
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004550:Elbow / Q000503:physiopathology*; D005260:Female; D006225:Hand / Q000503:physiopathology*; D006801:Humans; D006811:Humerus; D008297:Male; D059348:Peripheral Nerve Injuries / Q000503:physiopathology* / Q000601:surgery*; D011826:Radial Nerve / Q000293:injuries*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013497:Sural Nerve / Q000637:transplantation*; D016896:Treatment Outcome; D055815:Young Adult
keywords: BMRC = British Medical Research Council; ECRB = extensor carpi radialis brevis; ECRL = extensor carpi radialis longus; EDC = extensor digitorum communis; EPL = extensor pollicis longus; FCR = flexor carpi radialis; FCU = flexor carpi ulnaris; FDS = flexor digitorum superficialis; PIN = posterior interosseous nerve; PL = palmaris longus; nerve grafting; nerve transfer; neurotization; peripheral nerve; radial nerve palsy