Optimal axon counts for brachial plexus nerve transfers to restore elbow flexion. 2015

Joseph J Schreiber, and David J Byun, and Mahmoud M Khair, and Lauren Rosenblatt, and Steve K Lee, and Scott W Wolfe
New York, N.Y. From the Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery.

BACKGROUND Nerve transfer surgery has revolutionized the management of traumatic brachial plexus injures. However, the optimal size ratio of donor to recipient nerve has yet to be elucidated. The authors investigated the axon count ratios of ulnar and median fascicular transfers to restore elbow flexion. The authors hypothesized that donor nerve axon counts would be correlated with historical success of various nerve transfers used to restore elbow flexion. METHODS Ten cadaveric specimens were used for a histomorphologic analysis of fascicular nerve transfers. Review of previously published axon counts and clinical results following transfer to the musculocutaneous nerve to restore elbow flexion was performed for the following donor nerves: medial pectoral, spinal accessory, intercostal, thoracodorsal, ulnar, and median fascicular. RESULTS The average number of fascicles identified was 7.9 in the ulnar nerve and 8.0 in the median nerve. The mean fascicular axon count was 1318 for the ulnar nerve and 1860 for the median nerve. Mean recipient nerve axon count was 1826 for the musculocutaneous biceps branch and 1840 for the brachialis branch. A significant correlation between axon count and clinical results of transfers to restore elbow flexion was observed. Donor-to-recipient nerve axon count ratios below 0.7:1 were associated with a decreased likelihood of a successful outcome. CONCLUSIONS In nerve transfers to restore elbow flexion, an appropriate size match between donor and recipient nerves appears to be a factor affecting clinical success. These data support a donor-to-recipient axon count ratio greater than 0.7:1 as the goal for brachial plexus nerve transfers to restore elbow flexion.

UI MeSH Term Description Entries
D008475 Median Nerve A major nerve of the upper extremity. In humans, the fibers of the median nerve originate in the lower cervical and upper thoracic spinal cord (usually C6 to T1), travel via the brachial plexus, and supply sensory and motor innervation to parts of the forearm and hand. Median Nerves,Nerve, Median,Nerves, Median
D001917 Brachial Plexus The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (C5-C8 and T1), but variations are not uncommon. Plexus, Brachial
D002102 Cadaver A dead body, usually a human body. Corpse,Cadavers,Corpses
D004551 Elbow Joint A hinge joint connecting the FOREARM to the ARM. Elbow Joints,Joint, Elbow,Joints, Elbow
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001369 Axons Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. Axon
D014459 Ulnar Nerve A major nerve of the upper extremity. In humans, the fibers of the ulnar nerve originate in the lower cervical and upper thoracic spinal cord (usually C7 to T1), travel via the medial cord of the brachial plexus, and supply sensory and motor innervation to parts of the hand and forearm. Nerve, Ulnar,Nerves, Ulnar,Ulnar Nerves
D016059 Range of Motion, Articular The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate MUSCLE STRETCHING EXERCISES. Passive Range of Motion,Joint Flexibility,Joint Range of Motion,Range of Motion,Flexibility, Joint
D016067 Nerve Transfer Surgical reinnervation of a denervated peripheral target using a healthy donor nerve and/or its proximal stump. The direct connection is usually made to a healthy postlesional distal portion of a non-functioning nerve or implanted directly into denervated muscle or insensitive skin. Nerve sprouts will grow from the transferred nerve into the denervated elements and establish contact between them and the neurons that formerly controlled another area. Nerve Crossover,Neurotization,Crossover, Nerve,Crossovers, Nerve,Nerve Crossovers,Nerve Transfers,Neurotizations,Transfer, Nerve,Transfers, Nerve
D020516 Brachial Plexus Neuropathies Diseases of the cervical (and first thoracic) roots, nerve trunks, cords, and peripheral nerve components of the BRACHIAL PLEXUS. Clinical manifestations include regional pain, PARESTHESIA; MUSCLE WEAKNESS, and decreased sensation (HYPESTHESIA) in the upper extremity. These disorders may be associated with trauma (including BIRTH INJURIES); THORACIC OUTLET SYNDROME; NEOPLASMS; NEURITIS; RADIOTHERAPY; and other conditions. (From Adams et al., Principles of Neurology, 6th ed, pp1351-2) Brachial Plexopathy,Erb Paralysis,Klumpke Paralysis,Brachial Plexus Diseases,Brachial Plexus Disorders,Dejerine-Klumpke Palsy,Erb's Palsy,Erb-Duchenne Paralysis,Klumpke's Palsy,Lower Brachial Plexus Neuropathy,Lower Brachial Plexus Palsy,Middle Brachial Plexus Neuropathy,Paralysis of the Lower Brachial Plexus,Upper Brachial Plexus Neuropathy,Brachial Plexus Disease,Brachial Plexus Disorder,Brachial Plexus Neuropathy,Dejerine Klumpke Palsy,Erb Duchenne Paralysis,Erb Palsy,Erb Paralyses,Erb's Palsies,Erb-Duchenne Paralyses,Erbs Palsy,Klumpke Palsy,Klumpkes Palsy,Neuropathies, Brachial Plexus,Neuropathy, Brachial Plexus,Palsies, Erb's,Palsy, Dejerine-Klumpke,Palsy, Erb's,Palsy, Klumpke's,Paralyses, Erb,Paralyses, Erb-Duchenne,Paralysis, Erb,Paralysis, Erb-Duchenne,Paralysis, Klumpke,Plexopathies, Brachial,Plexopathy, Brachial,Plexus Disease, Brachial,Plexus Diseases, Brachial,Plexus Disorder, Brachial,Plexus Disorders, Brachial,Plexus Neuropathies, Brachial,Plexus Neuropathy, Brachial

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