The First Experience of Triple Nerve Transfer in Proximal Radial Nerve Palsy.

Research paper by Mohammadreza M Emamhadi, Sasan S Andalib

Indexed on: 19 Oct '17Published on: 19 Oct '17Published in: World Neurosurgery


Injury to distal of posterior cord of brachial plexus leads to palsy of the radial and axillary nerves. The symptoms are usually motor deficits of the deltoid muscle, triceps brachii muscle, and the extensor muscles of the wrist, thumb and fingers. Tendon transfers, nerve grafts, and nerve transfers are options of surgical treatment of proximal radial nerve palsy to restore some motor functions. Tendon transfer is painful, requires a long immobilization, and decreases donor muscle strength; nevertheless, nerve transfer produces promising outcome. Here, we present a patient with proximal radial nerve palsy following a blunt injury.Our patient was involved in a motorcycle accident with complete palsy of the radial and axillary nerves. Six months later on admission, he showed a spontaneous recovery in axillary nerve, but radial palsy remained. We performed triple nerve transfers, a fascicle of ulnar nerve to long head of triceps branch of radial nerve, flexor digitorum superficialis branch of median nerve to extensor carpi radialis brevis (ECRB) branch of radial nerve, and flexor carpi radialis branch of median nerve to posterior interoseous nerve for restoration of elbow, wrist, and finger extensions, respectively.Our experience confirmed functional elbow, wrist, and finger extensions.Triple nerve transfers will restore functions of upper limb in patients who presented with debilitating radial nerve palsy after blunt injuries.