American Society for Peripheral Nerve

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Oberlin Nerve Transfer Confers Early Elbow flexion and Forearm Supination in Neonatal Brachial Plexus Palsy
Kate Wan-Chu Chang, MA, MS; Miriana Popadich, NP; Lynda Yang, MD, PhD
University of Michigan, Ann Arbor, MI

Introduction: The use of nerve transfers for Neonatal Brachial Plexus Palsy (NBPP) remains controversial. However, supportive evidence for nerve transfers includes potential early reinnervation and improved functional outcomes, potentially via earlier cortical reorganization. The Oberlin nerve transfer (ulnar nerve fascicle to biceps branch of the musculocutaneous nerve) results in excellent restoration of elbow flexion in adults. Infants lacking upper trunk function require restoration of not only active elbow flexion but also supination to avoid muscle contractures and consequent pronation deformity -- both of which can yield significant physical and psychosocial detriments in children. We report the functional results from a series of infants with NBPP who have undergone the Oberlin transfer.

Materials and Methods: This case series reviewed 19 patients who underwent the Oberlin transfer by one neurosurgeon at a single institution, from ages 5 to 11 months (mean age 7 months). Patients' demographics, NBPP involved side, Narakas scale, lesion type, and operative descriptions were reported. Post-operative active range of motion in elbow flexion (in adduction and abduction), forearm supination and pronation were assessed by 1 of 2 certified occupational therapists pre-operatively and post-operatively at Time A (3-5 months), Time B (6-9 months), and Time C (10-12 months). Biceps muscle strength was evaluated via Medical Research Council (MRC) muscle grading scale. Paired T-Test was used to report pre- and post-operative comparisons for elbow and forearm functions.

Results: Elbow flexion in adduction showed significant improvement post-operatively at Time B (72°±40°, P=0.001) and C (82°±37°, P=0.001), when compared to pre-operative measures (28°±35°). A similar trend was presented in elbow flexions in abduction (pre-op=51°±45° vs. Time B=95°±54°, P=0.007; Time C=108°±39°, P <0.0001). MRC strength of biceps increased from grade 2 to grade 3 by Time C. On interest, forearm supination improved from -67°±38° to -26°±65° at Time A (P=0.041), -12° ± 66° at Time B (P=0.029), and 31°± 39° at Tme C (P<0.0001) while forearm pronation remained 90° pre-and post-operatively.

Conclusions: We demonstrate that the use of Oberlin transfer in infants with NBPP demonstrates advantageous early recoveries in both elbow flexion and forearm supination. As use of nerve transfers increases among surgeons (for reasons including decreased operative time, avoidance of the injured/scarred region, etc.), more studies are needed to establish the comparative outcomes after nerve transfer vs graft and to establish the indications for these procedures.


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