American Society for Peripheral Nerve

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A Comparison of Postoperative Elbow Flexion Strength After Intercostal and Oberlin's Nerve Transfer
Kevin T Rezzadeh, BA, New York University School of Medicine, New York, NY, Megan Donnelly, BS, NYU School of Medicine, New York, NY, David Daar, MD, New York University Langone Health, New York, NY and Jacques Hacquebord, MD, NYU Langone Medical Center, New York, NY


Both extraplexal and intraplexal nerve donors can be used to restore functionality to the upper extremity after brachial plexus injury. In this pooled analysis, we compare the intercostal nerve and the ulnar nerve fascicles as nerve donors for reinnervation of the bicep. We hypothesize that intercostal nerve transfer will produce worse results than Oberlin's transfer.


A systematic review was conducted according to PRISMA guidelines. Inclusion criteria were studies reporting outcomes on patients undergoing ICN nerve transfer or Oberlin's transfer for restoration of elbow flexion. Patients were excluded for the following reasons: age<18 and follow-up<12 months. Pooled analysis was performed, and the primary outcome analyzed was elbow flexion MRC score. Comparisons between ICN transfer group and Oberlin's transfer group were made using chi-squared test for categorical variables and independent samples t-test for continuous variables.


There were 24 studies (217 patients) included in this analysis. The ICN transfer group had significantly greater extent of injury (p<0.001), but shorter preoperative delay (4.6 months vs. 8.0 months, p<0.009) and more extended follow-up (46.8 months vs. 26.6 months, p<0.001). The ICN group had significantly worse mean elbow flexion MRC scores at final follow-up (2.9 vs 3.4, p=0.036).


Extraplexal nerve donors such as the intercostal nerve may perform worse than intraplexal nerve donors in restoring elbow flexion; however, they remain a valuable option in patients with total brachial plexus injury.

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