Comparative Study of Phrenic and Intercostal Nerve Transfers for Elbow Flexion After Global Brachial Plexus Injury

Abstract

Objective: The aim of this study was to compare phrenic and intercostal nerve transfers for elbow flexion after global brachial plexus injury. Methods: A retrospective review of 33 patients treated with phrenic and intercostal nerve transfer for elbow flexion in posttraumatic global root avulsion brachial plexus injury was carried out. Phrenic nerve transfer group: phrenic nerve was transferred to anterolateral bundle of anterior division of upper trunk (23 patients); intercostal nerve transfer group: three intercostal nerves were coapted to the anterolateral bundles of musculocutaneous nerve. The British Medical Research Council (MRC) grading system, angle of elbow flexion, and electromyography (EMG) were used to evaluate the recovery of elbow flexion at least 3 years after surgery. Results: The efficiency of motor function in phrenic nerve transfer group was 83%, while it was 70% in intercostal nerve transfer group. The 2 groups were not statistically different in terms of MRC grade ( P = .646) and EMG results ( P = .646). The outstanding rates of angle of elbow flexion were 48% and 40% in phrenic and intercostal nerve transfer groups, respectively. There was no significant difference of outstanding rates in angle of elbow flexion between the 2 groups. Conclusion: Phrenic nerve transfer had a higher proportion of good prognosis for elbow flexion than intercostal nerve transfer, but the effective and outstanding rate had no significant difference for biceps reinnervation between the 2 groups according to MRC grading, angle of elbow flexion, and EMG.