Transfer of the recovered biceps to the long flexors of the digits to restore grip function following complete traumatic brachial plexus palsy

Abstract

Restoration of grip function was achieved through transfer of the recovered biceps tendon to the long digital flexors using a fascia lata graft in seven patients with complete brachial plexus palsy. Initial nerve repair was followed by biceps transfer with stabilising wrist and hand fusions. The biceps recovered to Medical Research Council (MRC) grade 4 in all cases. Patients were reviewed at a mean time of 26.7 (range 7–63) months after biceps transfer. After transfer, the total active movement of the digits averaged 55 (range 30–90)°. The strongest measurable grip strength was 6 kg. Patient satisfaction was high. The excellent excursion of the elbow provides a good basis for a transfer to power grip function, enabling a greater total active movement of the fingers to be achieved. We recommend this method as a useful adjunct to the treatment of the complete brachial plexus palsy.