Clinical outcomes following median to radial nerve transfers

Abstract

Purpose: To evaluate the clinical outcomes in patients with radial nerve palsy who underwent nerve transfers using redundant fascicles of median nerve (innervating the flexor digitorum superficialis and flexor carpi radialis muscles) to the posterior interosseous nerve and the nerve to the extensor carpi radialis brevis.

Methods: This was a retrospective review of the clinical records of 19 patients with radial nerve injuries who underwent nerve transfer procedures using the median nerve as a donor nerve. All patients were evaluated using the Medical Research Council (MRC) grading system. The mean age of patients was 41 years (range, 17-78 y). All patients received at least 12 months of follow-up (range, 20.3 ± 5.8 mo). Surgery was performed at a mean of 5.7 ± 1.9 months postinjury.

Results: Postoperative functional evaluation was graded according to the following scale: grades MRC 0/5 to MRC 2/5 were considered poor outcomes, whereas an MRC grade of 3/5 was a fair result, 4/5 was a good result, and 4+/5 was an excellent outcome. Postoperatively, all patients except one had good to excellent recovery of wrist extension. A total of 12 patients recovered good to excellent finger and thumb extension, 2 had fair recovery, and 5 had poor recovery.

Conclusions: The radial nerve is commonly injured, causing severe morbidity in affected patients. The median nerve provides a reliable source of donor nerve fascicles for radial nerve reinnervation. The important nuances of both surgical technique and motor reeducation critical for the success of this transfer have been identified and are discussed.

Type of study/level of evidence: Therapeutic IV.

Figure 1

Figure 1A) Our initial technique involved utilization of fascicles from the PL and FDS. (Adapted by permission from Plastics and Reconstructive Surgery; Elsevier. 2002; 110(3):836–843, Lowe JB, Tung TR, Mackinnon SE. New Surgical Option for Radial Nerve Paralysis) Figure 1B) Further evolution of the transfer technique with all fascicles of FDS nerve and FCR nerve coadapted to ECRB nerve and PIN without separation of individual donor and recipient branches. (Adapted by permission from Hand Clinics; Elsevier. 2008 Nov; 24(4):319–340, Brown JM, Mackinnon SE. Nerve transfers of the forearm and hand) Figure 1C) Illustration of our current preferred technique, FDS nerve to ECRB nerve and FCR nerve to PIN.

Figure 1

Figure 1A) Our initial technique involved utilization of fascicles from the PL and FDS. (Adapted by permission from Plastics and Reconstructive Surgery; Elsevier. 2002; 110(3):836–843, Lowe JB, Tung TR, Mackinnon SE. New Surgical Option for Radial Nerve Paralysis) Figure 1B) Further evolution of the transfer technique with all fascicles of FDS nerve and FCR nerve coadapted to ECRB nerve and PIN without separation of individual donor and recipient branches. (Adapted by permission from Hand Clinics; Elsevier. 2008 Nov; 24(4):319–340, Brown JM, Mackinnon SE. Nerve transfers of the forearm and hand) Figure 1C) Illustration of our current preferred technique, FDS nerve to ECRB nerve and FCR nerve to PIN.

Figure 1

Figure 1A) Our initial technique involved utilization of fascicles from the PL and FDS. (Adapted by permission from Plastics and Reconstructive Surgery; Elsevier. 2002; 110(3):836–843, Lowe JB, Tung TR, Mackinnon SE. New Surgical Option for Radial Nerve Paralysis) Figure 1B) Further evolution of the transfer technique with all fascicles of FDS nerve and FCR nerve coadapted to ECRB nerve and PIN without separation of individual donor and recipient branches. (Adapted by permission from Hand Clinics; Elsevier. 2008 Nov; 24(4):319–340, Brown JM, Mackinnon SE. Nerve transfers of the forearm and hand) Figure 1C) Illustration of our current preferred technique, FDS nerve to ECRB nerve and FCR nerve to PIN.