Nerve Transfers for an Upper Brachial Plexus Injury: A Case Report

Abstract

Objective: To demonstrate multiple nerve transfers as primary surgical management for an upper
plexus injury.
Methods: A 6-year-old boy who suffered a preganglionic upper brachial plexus injury following a motor vehicle accident, exhibited complete biceps, deltoids, suprapinatus, and infraspinatus palsies.
Multiple nerve transfers, which consist of spinal accessory nerves to suprascapular nerve transfer, median and ulnar motor fascicles to biceps and brachialis motor branches transfers, and long head of
triceps motor branch to axillary nerve transfer were performed 6 months after injury.
Results: 13 months post multiple nerve transfer, the patient has regained M4+/5 elbow flexion, M4/5 external rotation, and M4/5 shoulder abduction.
Conclusion: Nerve transfer is a viable option for upper plexus palsy management. With a sound surgical technique and good case selection, the results can be very rewarding. This case showed
quite robust re-innervation with significant functional recovery at a one-year follow-up following multiple nerve transfers.
Keywords: Brachial Plexus Injury, Upper Plexus Injury, Nerve Root Avulsion, Nerve Transfers, Functional Recovery.