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J Neurol Surg A Cent Eur Neurosurg 2020; 81(06): 571-574
DOI: 10.1055/s-0039-3400950
Case Report

Delayed Transfer of the Extensor Carpi Radialis Brevis Branch of the Radial Nerve to the Anterior Interosseous Nerve for Restoration of Thumb and Index Finger Flexion: Case Report

Renan Salomão
1   Division of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
,
Jairo Porfírio de Oliveira Jr
1   Division of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
,
Carolina Fernandes Junger
1   Division of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
,
Luiz Cezar Soares Ricardo Jr
1   Division of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
,
Carlos Roberto de Lima
1   Division of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
,
Marcus Andre Acioly
1   Division of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
2   Division of Neurosurgery, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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Abstract

High median nerve injuries (HMNIs) are rare lesions involving the upper extremities and affect the median nerve from its origin to the emergence of the anterior interosseous nerve (AIN). Proximal reconstruction has long been considered the gold standard in treating HMNI, but thumb and index flexion and pinch and grip weakness are consistently not recovered. We report the surgical results of a patient affected by an HMNI with partial spontaneous recovery after a gunshot wound. AIN function was successfully restored in a delayed fashion by transferring the radial nerve branch to the extensor carpi radialis brevis to the AIN.

Keywords

anterior interosseous nerve - finger flexion reconstruction - high median nerve injury - nerve transfer


Publication History

Received: 14 March 2019

Accepted: 09 July 2019

Article published online:
03 May 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Ko JW, Mirarchi AJ. Late reconstruction of median nerve palsy. Orthop Clin North Am 2012; 43 (04) 449-457
    CrossrefPubMedGoogle Scholar
  • 2 Bertelli JA, Soldado F, Lehn VL, Ghizoni MF. Reappraisal of clinical deficits following high median nerve injuries. J Hand Surg Am 2016; 41 (01) 13-19
    CrossrefPubMedGoogle Scholar
  • 3 Boswick Jr JA, Stromberg Jr WB. Isolated injury to the median nerve above the elbow. A review of thirteen cases. J Bone Joint Surg Am 1967; 49 (04) 653-658
    CrossrefPubMedGoogle Scholar
  • 4 Soldado F, Bertelli JA, Ghizoni MF. High median nerve injury: motor and sensory nerve transfers to restore function. Hand Clin 2016; 32 (02) 209-217
    CrossrefPubMedGoogle Scholar
  • 5 Bertelli JA. Transfer of the radial nerve branch to the extensor carpi radialis brevis to the anterior interosseous nerve to reconstruct thumb and finger flexion. J Hand Surg Am 2015; 40 (02) 323-328.e2
    CrossrefPubMedGoogle Scholar
  • 6 Hsiao EC, Fox IK, Tung TH, Mackinnon SE. Motor nerve transfers to restore extrinsic median nerve function: case report. Hand (N Y) 2009; 4 (01) 92-97
    CrossrefPubMedGoogle Scholar
  • 7 Murphy RK, Ray WZ, Mackinnon SE. Repair of a median nerve transection injury using multiple nerve transfers, with long-term functional recovery. J Neurosurg 2012; 117 (05) 886-889
    CrossrefPubMedGoogle Scholar
  • 8 Socolovsky M, Bonilla G, Masi GD, Bianchi H. Transfer of flexor carpi ulnaris branches to selectively restore AIN function in median nerve sections: anatomical feasibility study and case report. Surg Neurol Int 2011; 2: 102
    CrossrefPubMedGoogle Scholar
  • 9 Sedain G, Sharma MS, Sharma BS, Mahapatra AK. Outcome after delayed Oberlin transfer in brachial plexus injury. Neurosurgery 2011; 69 (04) 822-827 ; discussion 827–828
    CrossrefPubMedGoogle Scholar
  • 10 Goubier JN, Teboul F. Management of hand palsies in isolated C7 to T1 or C8, T1 root avulsions. Tech Hand Up Extrem Surg 2008; 12 (03) 156-160
    CrossrefPubMedGoogle Scholar
  • 11 Sammer DM, Chung KC. Tendon transfers: Part II. Transfers for ulnar nerve palsy and median nerve palsy. Plast Reconstr Surg 2009; 124 (03) 212e-221e
    CrossrefPubMedGoogle Scholar
  • 12 Bertelli JA, Mendes Lehm VL, Tacca CP, Winkelmann Duarte EC, Ghizoni MF, Duarte H. Transfer of the distal terminal motor branch of the extensor carpi radialis brevis to the nerve of the flexor pollicis longus: an anatomic study and clinical application in a tetraplegic patient. Neurosurgery 2012; 70 (04) 1011-1016 ; discussion 1016
    CrossrefPubMedGoogle Scholar
  • 13 García-López A, Sebastian P, Martinez F, Perea D. Transfer of the nerve to the brachioradialis muscle to the anterior interosseous nerve for treatment for lower brachial plexus lesions: case report. J Hand Surg Am 2011; 36 (03) 394-397
    CrossrefPubMedGoogle Scholar
  • 14 Gu Y, Wang H, Zhang L, Zhang G, Zhao X, Chen L. Transfer of brachialis branch of musculocutaneous nerve for finger flexion: anatomic study and case report. Microsurgery 2004; 24 (05) 358-362
    CrossrefPubMedGoogle Scholar
  • 15 Ray WZ, Yarbrough CK, Yee A, Mackinnon SE. Clinical outcomes following brachialis to anterior interosseous nerve transfers. J Neurosurg 2012; 117 (03) 604-609
    CrossrefPubMedGoogle Scholar
  • 16 Yang J, Jia X, Yu C, Gu Y. Pronator teres branch transfer to the anterior interosseous nerve for treating C8T1 brachial plexus avulsion: an anatomic study and case report. Neurosurgery 2014; 75 (04) 375-379 ; discussion 379
    CrossrefPubMedGoogle Scholar