Results of nerve transfer techniques for restoration of shoulder and elbowfunction in the context of a meta-analysis of the English literature

We report the results of 15 patients who underwent nerve transfer for resto ration of shoulder and elbow function at our institution for traumatic brac hial plexus palsy. We present these results in the context of a meta-analys is of the English literature, designed to quantitatively assess the efficac y of individual nerve transfers for restoration of elbow and shoulder funct ion in a large number of patients. One thousand eighty-eight nerve transfer s from 27 studies met the inclusion criteria of the analysis. Seventy-two p ercent of direct intercostal to musculocutaneous transfers (without interpo sition nerve grafts) achieved biceps strength greater than or equal to M3 v ersus 47% using interposition grafts. Direct intercostal transfers to the m usculocutaneous nerve had a better ability to achieve greater than or equal to M4 elbow strength than transfers from the spinal accessory nerve (41% v s 29%). The suprascapular nerve fared significantly better than the axillar y nerve in obtaining greater than or equal to M3 shoulder abduction (92% vs 69%). At our institution 90% of intercostal to musculocutaneous transfers (n = 10)achieved greater than or equal to M3 bicep strength and 70% achieve d greater than or equal to M4 strength. Four of seven patients achieved gre ater than or equal to M3 shoulder abduction with a single nerve transfer an d 6 of 7 regained greater than or equal to M3 strength with a dual nerve tr ansfer. This study suggests that interposition nerve grafts should be avoid ed when possible when performing nerve transfers. Better results fur restor ation of elbow flexion have been attained with intercostal to musculocutane ous transfers than with spinal accessory nerve transfers and spinal accesso ry to suprascapular transfers appear to have the best outcomes for return o f shoulder abduction. We conclude that nerve transfer is an effective means to restore elbow and shoulder function in brachial plexus paralysis. (J Ha nd Surg 2001;26A:303-314. Copyright (C) 2001 by the American Society for Su rgery of the Hand.).