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Background: In brachial plexus injuries, when there are no available roots to use as a source for graft reconstruction, nerve transfers emerge as an elective technique. For this purpose, transfer of an ulnar nerve fascicle to the biceps motor branch (Oberlin's procedure) is often used. Despite the high rate of good to excellent results in adults, this technique is seldom used in children., Objective: To evaluate the efficacy and safety of Oberlin's procedure in the surgical treatment of brachial plexus birth palsy., Methods: Striving to restore elbow flexion, we performed Oberlin's procedure in 17 infants with brachial plexus birth palsy. After follow-up of at least 19 months, primary outcomes were the strength of elbow flexion (modified British Medical Research Council scale), hand function measured using Al-Qattan's scale, and comparative x-rays of both hands to detect altered growth., Results: Good to excellent results related to biceps contraction were obtained in 14 patients (82.3%) (3/MRC3, 11/MRC4). The preoperative Al-Qattan scale score for the hand was maintained at final follow-up. Comparing the treated and normal limb, no difference was observed in hand development by x-ray., Conclusion: Oberlin's procedure is an effective and safe option for the surgical treatment of upper brachial plexus birth palsy.

Background: Nerve transfers or graft repairs in upper brachial plexus palsies are 2 available options for elbow flexion recovery., Objective: To assess outcomes of biceps muscle strength when treated either by grafts or nerve transfer., Methods: A standard supraclavicular approach was performed in all patients. When roots were available, grafts were used directed to proximal targets. Otherwise, a distal ulnar nerve fascicle was transferred to the biceps branch. Elbow flexion strength was measured with a dynamometer, and an index comparing the healthy arm and the operated-on side was developed. Statistical analysis to compare both techniques was performed., Results: Thirty-five patients (34 men) were included in this series. Mean age was 28.7 years (standard deviation, 8.7). Twenty-two patients (62.8%) presented with a C5-C6 injury, whereas 13 patients (37.2%) had a C5-C6-C7 lesion. Seventeen patients received reconstruction with grafts, and 18 patients were treated with a nerve transfer from the ulnar nerve to the biceps. The trauma to surgery interval (mean, 7.6 months in both groups), strength in the healthy arm, and follow-up duration were not statistically different. On the British Medical Research Council muscle strength scale, 8 of 17 (47%) patients with a graft achieved ≥ M3 biceps flexion postoperatively, vs 16 of 18 (88%) post nerve transfers (P = .024). This difference persisted when a muscle strength index assessing improvement relative to the healthy limb was used (P = .031)., Conclusion: The results obtained from ulnar nerve fascicle transfer to the biceps branch were superior to those achieved through reconstruction with grafts.

Background and Importance: Restoration of elbow extension has not been considered of much importance regarding functional outcomes in brachial plexus surgery; however, the flexion of the elbow joint is only fully effective if the motion can be stabilized, what can be achieved solely if the triceps brachii is coactivated. To present a novel nerve transfer of a healthy motor fascicle from the ulnar nerve to the nerve of the long head of the triceps to restore the elbow extension function in brachial plexus injuries involving the upper and middle trunks., Clinical Presentation: Case 1 is a 32-year-old man sustaining a right brachial extended upper plexus injury in a motorcycle accident 5 months before admission. The computed tomography myelogram demonstrated avulsion of the C5 and C6 roots. Case 2 is a 24-year-old man who sustained a C5-C7 injury to the left brachial plexus in a traffic accident 4 months before admission. Computed tomography myelogram demonstrated signs of C6 and C7 root avulsion. The technique included an incision at the medial border of the biceps, in the proximal third of the involved arm, followed by identification of the ulnar nerve, the radial nerve, and the branch to the long head of the triceps. The proximal stump of a motor fascicle from the ulnar nerve was sutured directly to the distal stump of the nerve of the long head of the triceps. Techniques to restore elbow flexion and shoulder abduction were applied in both cases. Triceps strength Medical Research Council M4 grade was obtained in both cases., Conclusion: The attempted nerve transfer was effective for restoration of elbow extension in primary brachial plexus surgery; however, it should be selected only for cases in which other reliable donor nerves were used to restore elbow flexion.

Background: Nerve transfers following traumatic brachial plexus injuries are infrequently operated on after 6 months of injury because myoneural degeneration may set in before nerve regeneration can occur. An exception may lie in transferring healthy donor nerve fascicles directly onto an injured recipient nerve close to the motor point. This is especially true of the Oberlin transfer in which ulnar nerve fascicle(s) are transferred onto the damaged nerve to the biceps., Objective: This retrospective observational study evaluated the outcome of the Oberlin transfer on bicipital power in patients with upper trunk/C5,6,7 root level injuries operated on after 6 months of injury., Methods: Using a standard infraclavicular exposure, the musculocutaneous nerve was followed to its branch to the biceps. Distal to this, the ulnar nerve was skeletonized and a constituent motor fascicle was transferred onto the nerve to biceps. Medical Research Council (MRC) motor power grading was assessed every 3 months following surgery. Patients with a follow-up less than 12 months were excluded., Results: Nine patients operated on after an average of 12.2 months (range, 7-24 months) following injury qualified for the study. At an average follow-up of 26.7 months (range, 12-41 months), all patients had ≥ 2/5 biceps power. Seven patients (77.8%) had useful biceps function ≥ 3/5 MRC score. A single patient operated on 24 months after injury gained 4/5 MRC biceps power., Conclusion: The Oberlin transfer is a useful salvage procedure in patients presenting after 6 months of a brachial plexus injury.

Background: Injuries to the upper trunk of the brachial plexus are debilitating, affecting primarily shoulder abduction and elbow flexion. Treatment is aimed at restoring shoulder stabilization, shoulder abduction, and elbow flexion and may be accomplished by nerve grafting, nerve transfer, or functional muscular transfer., Objective: To describe the double fascicular nerve transfer with the goal of restoring elbow flexion., Methods: The double fascicular nerve transfer involves transferring an ulnar nerve fascicle to the musculocutaneous nerve innervating the biceps muscle and a median nerve fascicle transfer to a branch of musculocutaneous nerve supplying the brachialis muscle., Results: The double fascicular nerve transfer is effective in restoring elbow flexion after severe upper-trunk brachial plexus injuries., Conclusion: Advantages of this procedure are that the nerve repair is done very close to the target muscle for reinnervation, so time to reinnervation is minimized, and the surgery takes place distal to the site of injury in nontraumatized tissue.