Full-length phrenic nerve transfer as the treatment for brachial plexus avulsion injury to restore wrist and finger extension

Introduction: The functional restoration of wrist and finger extension after complete brachial plexus avulsion injury remains an unsolved problem. We conducted a prospective study to elucidate a new method for resolving this injury. Methods: Six patients with complete brachial plexus avulsion injury underwent a new surgical procedure in which the full-length phrenic nerve was transferred to the medial portion of the radial nerve at the level of the latissimus dorsi insertion via endoscopic thoracic surgery. Results: In 5 patients, extensor carpi ulnaris and extensor carpi radialis strength recovered to Medical Research Council grade =M3, and in 4 patients extensor digitorum strength recovered to =M3. Conclusions: Neurotization of phrenic nerve to the medial portion of the radial nerve at the level of latissimus dorsi insertion is a feasible means of restoring wrist and finger extension in cases of complete brachial plexus avulsion injury. Muscle Nerve 45: 3942, 2012