Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Dec;130(6):1269-1278.
doi: 10.1097/PRS.0b013e31826d16cf.

Transfer of the pronator quadratus motor branch for wrist extension reconstruction in brachial plexus palsy

Jayme A Bertelli  1 , Cristiano P Tacca, Elisa C Winkelmann Duarte, Marcos F Ghizoni, Hamilton Duarte
Affiliations

Transfer of the pronator quadratus motor branch for wrist extension reconstruction in brachial plexus palsy

Jayme A Bertelli et al. Plast Reconstr Surg. 2012 Dec.

Abstract

Background: In extended upper-type lesions of the brachial plexus, nerve transfers and root grafting have improved the results of shoulder and elbow reconstruction. However, wrist extension reconstruction has received little attention.

Methods: In 20 cadaveric upper limbs, we dissected the anterior interosseous nerve and extensor carpi radialis brevis motor branch. Four patients with upper-type lesions of the brachial plexus with paralysis of wrist and finger extension were operated on within 10 months of trauma and followed up for 12 months after surgery. The terminal division of the anterior interosseous nerve, which innervates the pronator quadratus muscle, was transferred to the extensor carpi radialis brevis, and the distal stump was connected to a motor fascicle of the median nerve (n = 2) or to the distal branch of the flexor superficialis of the index finger (n = 2).

Results: The anterior interosseous nerve and extensor carpi radialis brevis had similar diameters (roughly 1 mm). The number of myelinated fibers in the nerve averaged 670, whereas the number in the extensor carpi radialis brevis averaged 183. The length of the nerve was approximately 80 mm, allowing for direct transfer to the extensor carpi radialis brevis with redundant length. At last evaluation, pronation scored M4 according to the Medical Research Council grading system. All patients recovered active wrist extension, scoring M4 with full, independent motor control.

Conclusion: In C5 to C8 root injuries of the brachial plexus, transfer of the motor branch of the pronator quadratus to the extensor carpi radialis brevis can restore active wrist extension, and pronation is preserved.

Clinical question/level of evidence: : Therapeutic, IV.

PubMed Disclaimer

References

    1. Bertelli JA, Ghizoni MF. C5-8 brachial plexus root injury: The “T-1 hand.” J Neurosurg. 2012;116:409–413.
    1. Krishnan KG, Schackert G. An analysis of results after selective tendon transfers through the interosseous membrane to provide selective finger and thumb extension in chronic irreparable radial nerve lesions. J Hand Surg Am. 2008;33:223–231.
    1. Bincaz LE, Cherifi H, Alnot JY. Palliative tendon transfer for reanimation of the wrist and finger extension lag: Report of 14 transfers for radial nerve palsies and ten transfers for brachial plexus lesions (in French). Chir Main 2002;21:13–22.
    1. Ukrit A, Leechavengvongs S, Malungpaishrope K, Uerpairojkit C, Chongthammakun S, Witoonchart K. Nerve transfer for wrist extension using nerve to flexor digitorum superficialis in cervical 5, 6, and 7 root avulsions: Anatomic study and report of two cases. J Hand Surg Am. 2009;34:1659–1666.
    1. Tubbs RS, Custis JW, Salter EG, Wellons JC III, Blount JP, Oakes WJ. Quantitation of and superficial surgical landmarks for the anterior interosseous nerve. J Neurosurg. 2006;104:787–791.