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Clinical Outcomes of Upper Extremity Nerve Transfers in Neuralgic Amyotrophy. 2023

Ogi Solaja, and Allison K Baergen, and Linden K Head, and Gerald K Wolff, and Kirsty U Boyd
From the Divisions of Plastic and Reconstructive Surgery.

Neuralgic amyotrophy (NA) is a disease affecting peripheral nerves. Treatment has historically been conservative, as the natural course of the disease was thought to be self-limiting. Recent work has demonstrated that as many as two-thirds of people with NA have persistent pain, fatigue, or weakness. At the authors' center, supercharged end-to-side (SETS) nerve transfers are commonly performed in patients with NA to optimize motor recovery while allowing for native axonal regrowth. The authors describe the technique and clinical outcomes of patients with NA affecting the anterior interosseous nerve (AIN) who were treated with SETS nerve transfer from extensor carpi radialis brevis to AIN. Ten patients (90% male; mean age, 51.3 ± 9.7 years) underwent extensor carpi radialis brevis-to-AIN transfer at a mean period of 6.4 ± 1.4 months after onset of symptoms. Mean postoperative follow-up duration was 14.8 ± 3.2 months. Before surgery, all patients demonstrated clinically significant weakness in the flexor pollicis longus (FPL), flexor digitorum profundus muscle to the index finger (FDP2), or both. FPL strength improved from a median Medical Research Council (MRC) grade of 1.5 to 4 ( P = 0.011) and FDP2 strength improved from a median MRC grade of 1 to 5 ( P = 0.016). A postoperative MRC grade of 4 or greater was achieved in nine of 10 (90%) FPL and 10 of 10 (100%) FDP muscles. This is the first report of SETS nerve transfer for the treatment of NA. The outcomes of this work suggest that SETS nerve transfers may be an option to optimize motor outcomes in patients with NA. Therapeutic, IV.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010525 Peripheral Nerves The nerves outside of the brain and spinal cord, including the autonomic, cranial, and spinal nerves. Peripheral nerves contain non-neuronal cells and connective tissue as well as axons. The connective tissue layers include, from the outside to the inside, the epineurium, the perineurium, and the endoneurium. Endoneurium,Epineurium,Perineurium,Endoneuriums,Epineuriums,Nerve, Peripheral,Nerves, Peripheral,Perineuriums,Peripheral Nerve
D005260 Female Females
D005385 Fingers Four or five slender jointed digits in humans and primates, attached to each HAND. Finger
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
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
D020968 Brachial Plexus Neuritis A syndrome associated with inflammation of the BRACHIAL PLEXUS. Clinical features include severe pain in the shoulder region which may be accompanied by MUSCLE WEAKNESS and loss of sensation in the upper extremity. This condition may be associated with VIRUS DISEASES; IMMUNIZATION; SURGERY; heroin use (see HEROIN DEPENDENCE); and other conditions. The term brachial neuralgia generally refers to pain associated with brachial plexus injury. (From Adams et al., Principles of Neurology, 6th ed, pp1355-6) Amyotrophy, Neuralgic,Cervico-Brachial Neuralgia,Neuralgia, Amyotrophic,Neuralgic Amyotrophy,Neuritis, Brachial Plexus,Parsonage-Turner Syndrome,Shoulder-Girdle Neuropathy,Amyotrophic Neuralgia,Amyotrophy, Hereditary Neuralgic,Amyotrophy, Hereditary Neuralgic, with Predilection for Brachial Plexus,Brachial Neuralgia,Brachial Neuritis,Brachial Plexus Neuropathy, Hereditary,Cervicobrachial Neuralgia,Familial Brachial Plexus Neuritis,Hereditary Brachial Plexus Neuropathy,Hereditary Neuralgic Amyotrophy,Heredofamilial Neuritis with Brachial Plexus Predilection,Neuritis With Brachial Predilection,Parsonage-Aldren-Turner Syndrome,Shoulder Girdle Neuropathy,Amyotrophic Neuralgias,Amyotrophies, Hereditary Neuralgic,Amyotrophies, Neuralgic,Brachial Neuralgias,Brachial Neuritides,Brachial Plexus Neuritides,Cervico Brachial Neuralgia,Cervico-Brachial Neuralgias,Cervicobrachial Neuralgias,Girdle Neuropathies, Shoulder,Girdle Neuropathy, Shoulder,Hereditary Neuralgic Amyotrophies,Neuralgia, Brachial,Neuralgia, Cervico-Brachial,Neuralgia, Cervicobrachial,Neuralgias, Amyotrophic,Neuralgias, Brachial,Neuralgias, Cervico-Brachial,Neuralgias, Cervicobrachial,Neuralgic Amyotrophies,Neuralgic Amyotrophies, Hereditary,Neuralgic Amyotrophy, Hereditary,Neuritides, Brachial,Neuritides, Brachial Plexus,Neuritis, Brachial,Neuropathies, Shoulder Girdle,Neuropathies, Shoulder-Girdle,Neuropathy, Shoulder Girdle,Neuropathy, Shoulder-Girdle,Parsonage Aldren Turner Syndrome,Parsonage Turner Syndrome,Shoulder Girdle Neuropathies,Shoulder-Girdle Neuropathies,Syndrome, Parsonage-Aldren-Turner,Syndrome, Parsonage-Turner
D034941 Upper Extremity The region of the upper limb in animals, extending from the deltoid region to the HAND, and including the ARM; AXILLA; and SHOULDER. Extremity, Upper,Membrum superius,Upper Limb,Extremities, Upper,Limb, Upper,Limbs, Upper,Upper Extremities,Upper Limbs

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