Elbow Extension Outcomes for Axillary to Triceps Nerve Transfer
Jasmine A. Thum, MD1, Luke D'Cunha, BS2, Stanley Bazarek, MD, PhD3 and Justin M. Brown, MD2, 1University of California, Los Angeles, Los Angeles, MA, 2Massachusetts General Hospital, Boston, MA, 3Brigham & Women's Hospital, Boston, MA
Introduction:
The triceps muscles are responsible for extension of the forearm at the elbow joint, and contribute to extension and adduction of the arm at the shoulder joint. As such, palsy of these muscles can be devastating to a person’s quality of life. With peripheral nerve transfers becoming an increasingly important tool for the reconstructive nerve surgeon, we report our outcomes with thus far poorly reported transfer for spinal cord injury (as well as brachial plexus or peripheral nerve injury) patients - the axillary nerve (AN) to long head of triceps (LHT) nerve transfer.
Methods & Materials:
Here, we report the results of axillary to LHT nerve transfers at our center. We include results from 15 SCI patients involving 21 limbs. We considered numerous factors that might influence outcomes including patient age, gender, time from injury to surgery, SCI injury anatomic level, and ASIA level. We report the extent and timing of recovery of elbow extension for each arm.
Results:
This study included the results of axillary to triceps nerve transfer in 21 limbs from 15 patients. 90% of limbs (19) experienced an improvement in elbow extension function, with 66% (14) of limbs gaining functional elbow extension (MRC 3 or above). The two limbs that did not experience any improvement were from the same patient, a 23 year old male with C4 injury. Surgery for this patient was performed 11 months after injury.
Conclusion:
With the growing utilization of nerve transfers in the reconstructive plan for SCI, BPI, and PN injuries, the efficacy of numerous nerve transfers still needs to be established. Here, we discuss our outcomes with one such transfer, the AN to LHT nerve transfer, which is gaining increased use in SCI patients to expand the patient’s reach and enable more functional interactions with their world, even from a motorized chair. Our outcomes showed favorable results, with 90% of patients having some improvement. Furthermore, this study shows that nerve transfer can be a viable option years after injury, insofar as LMN innervation to the target muscle is intact. Future work should be done to understand why some patients don’t respond well to surgery.
Back to 2024 Abstracts