Cases Of Brachial Plexus Injury Research Articles

Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach.

Global brachial plexus injury (GBPI) mainly affects adults and causes severe life-changing consequences that lead to the deterioration of patients' quality of life. Several surgical approaches have been described and reported in the literature to improve patients' functional ability. A literature review is done on PubMed/MEDLINE and Embase using specific keywords to retrieve relevant articles assessing different surgical approaches for GBPI management. Inclusion and exclusion criteria were applied, and eligible articles were included in the review. The literature survey revealed that various surgical options had been used to manage GBPI patients. In this concise review, we discuss and compare the different surgical approaches related to GBPI and its outcome in terms of restoring elbow flexion and extension, shoulder abduction, and wrist and hand function. The primary surgical intervention relies mainly on transferring single or multiple nerves with/without nerve grafts to restore the function of the targeted muscle. Different techniques using a variety of nerve donors and recipients are compared to assess the functional outcomes of each option. Moreover, further options are addressed for delayed GBPI injuries or failed nerve transfer procedures, as in free functional muscle transfer techniques. In addition, information about brachial plexus injury cases faced in our center is presented along with our center's approach to diagnosing and managing partial and GBPI cases.

Двухсторонняя брахиплексопатия после коррекции деформации Шейерманна: клинический случай

Introduction The article presents a case report and a brief literature review of an adverse event of brachial plexus injury associated with prone positioning in spinal surgery. The purpose was to report a case of bilateral brachial plexus injury after correction of Scheuermann's kyphosis. Material and methods Reported is a case of brachial plexus injury in a patient with Scheuermann's kyphosis after surgical correction. Results The patient could completely regain motor function of the left limb at 6 months with palsy scored 3 proximally retained in the right hand. Discussion The literature describes three pathophysiological conditions that predispose to brachial plexus injury in the postoperative period: sprain, compression, and ischemia. The adverse event is reversible in most cases and recovery depends on the degree of neurological deficit at an early stage. Recommendations are offered for surgeons and anesthesiologists to avoid the occurrence of the complication or take timely measures to alleviate the consequences. Conclusion Upperlimb somatosensory evoked potentials, a part of neurophysiological monitoring can be practical for prevention of the complication. Prevention of brachioplexopathy should be part of perioperative care.

Spinal accessory to suprascapular nerve transfer in brachial plexus injury: outcomes of anterior vs. posterior approach to the suprascapular nerve at associated ipsilateral spinal accessory nerve injury

Objective: The spinal accessory nerve (Acc) is susceptible to trauma in at least 6% of cases of brachial plexus injury (BPI). The impaired Acc function disables its utilization for transfer to the suprascapular nerve (SS). The selection of approach to SS is highly dependant on the anatomy of BPI. The purpose of this study was to determine the incidence of the anterior-posterior approach of Acc to SS transfer in BPI and associated functional outcomes. Methods. Twenty nine patients with BP/Acc associated injury were included. Ten patients underwent the transfer of Acc to SS by the anterior approach (AA), 19 patients – by the posterior approach (PA). Nine nerve transfers through AA and one nerve transfer through PA required the interposition of an autologous nerve graft. The functioning of the supra-/infraspinatus muscle was evaluated at 9 and 15mos. on the basis of the MRC and the external rotation (ER) range. ER more than +400 beyond the sagittal plane was regarded as effective recovery of function. Results. Impaired function (M3 or lower on MRC) of the lower trapezius muscle was associated with preserved anatomy of the SS in the supraclavicular region in 9 out of 10 cases. Eighteen patients (62%) recovered to M3 and higher (shoulder stability), 11of these (38%) showed recovery to M4-M5. Five of all patients recovered to M4-M5 and were able to produce ER within the effective ROM (+400-600 of ER). After the AA to the SS, shoulder stability was restored in 60% of cases (M4-M5 in 30%). After the PA to the SS, shoulder stability was restored in 74% of cases (M4-M5 in 42%). Only non-complete BPI showed effective recovery of power and function in terms of less than 6 mos. after injury. PA to SS with no graft provided shoulder stability in 72% of cases, AA to the SS and the graft interposition ensured shoulder stability in 50% of cases. Conclusions. The incidence of AA to the SS was 35%, PA – 65%; preserved anatomy of the SS in supraclavicular region was associated with an increased risk of trapezius muscle dysfunction; the PA to SS and consecutive direct end-to-end transfer of Acc showed better results compared to other combinations of nerve transfers in providing shoulder stability.

Comparative assessment of the health status of large for gestational age newborns

Our aim was to conduct a comparative assessment of the health status of large for gestational age (LGA) newborns. 348 full-term neonates who were born at the Republican Scientific and Practical Center “Mother and Child” were examined. The main group 1 (Gr1) consisted of 58 LGA newborns from mothers with diabetes mellitus (DM) type 1, the main group 2 (Gr2) consisted of 66 LGA babies from mothers without carbohydrate and lipid metabolism disorders, the main group 3 (Gr3) included 65 LGA babies from mothers with pregravid overweight or obesity, the control group (Gr4) had 159 newborns with the anthropometric parameters corresponding to the gestational age (AGA) from mothers without carbohydrate and lipid metabolism disorders. The negative impact of the mothers’ metabolic disorders on the newborns’ health status, functional state, and neuropsychological development was established. Babies born with macrosomia from mothers with DM were diagnosed with hypoglycemia, congenital pneumonia, hyperbilirubinemia, and neonatal encephalopathy much more often (p < 0.001). LGA babies from obese women were characterized by polycythemia, hyperbilirubinemia, and neonatal encephalopathy. Polycythemia, hyperbilirubinemia, and toxic erythema were often noted in Gr2 patients. The cases of brachial plexus injuries and limb fractures were not registered. A slower rate of neuropsychological development was noted in large neonates in the analyzed groups, and was more pronounced in infants from mothers with diabetes mellitus and obesity. LGA newborns from mothers with DM had a high hospitalization rate at the intensive care unit, followed by the separation of mother and child and a lower breastfeeding rate in the neonatal period. Large newborns from mothers with DM and from women with obesity had a higher probability of adverse neonatal outcomes and a reduced health status in the neonatal period.

A Case of Brachial Plexus Injury Following Anterior Dislocation of the Shoulder

A Case of Brachial Plexus Injury Following Anterior Dislocation of the Shoulder

Ultrasound-guided, long-axis, in-plane, infraclavicular axillary vein cannulation: A 6-year experience.

Despite its potential advantages, ultrasound-guided cannulation of the axillary vein in the infraclavicular area is still rarely used as an alternative to other techniques. There are few large series demonstrating the safety and feasibility of this approach. Retrospective analysis of data on patients undergoing ultrasound-guided, long-axis, in-plane infraclavicular axillary vein cannulation for the incidence of complications and the failure rate from two secondary-care hospitals. The analysis included 710 successful attempts of axillary vein long-axis, in-plane, US-guided cannulation, and 24 (3.3%) failed attempts. We recorded a 96.7% success rate with an overall incidence of complications of 13%, mainly malposition (8.1%). There was one case of pneumothorax (0.14%), five cases of arterial puncture (0.7%), and two cases of brachial plexus injury. The US-guided axillary central venous cannulation (CVC) access technique can be undertaken successfully in patients, even in challenging circumstances. Taken together with existing work on the utility and safety of this technique, we suggest that it should be adopted more widely in clinical practice.

A Single Surgeon's 10-Year Experience in Remote-Access Thyroid and Parathyroid Surgery.

Remote-access thyroid and parathyroid surgery has gained popularity recently due to its benefit of avoiding visible neck scars. Most of these techniques were described and performed in Asia, on patients with different body habitus compared to American patients. We aim to analyze the learning curve in performing these operations in North America. . This is a retrospective cohort study of a 10-year experience by a single surgeon at a North American institute. Patients who underwent thyroid or parathyroid procedures by a transaxillary, retroauricular, or transoral endoscopic thyroidectomy vestibular approach (TOETVA) were included. Cumulative sum (CUSUM) was used to analyze learning curves based on intraoperative blood loss and total operative times and learning phases were divided accordingly. Three hundred seventy-two remote-access thyroid and parathyroid procedures were performed during the study period. Total operative time for transaxillary procedures was initially reduced after the 69th procedure and then again after the 134th case. For retroauricular procedures, marked reduction in the operative time was observed after 21 procedures. Most patients (57.02%) were discharged home on the same day during the mastering phase. In the transaxillary procedures, only 1 case of brachial plexus injury occurred prior to the routine use of somatosensory evoked potential (SSEP) monitoring. Remote-access thyroid and parathyroid surgeries can be performed safely with minimal complications in a select group of patients. Analysis of the learning curve in performing these operations aids in structuring a safe and effective learning period for endocrine surgeons seeking to venture into this modality of treatment.

Pathophysiologic Origins of Brachial Plexus Injury.

To analyze the origins and consequences of cases of brachial plexus injuries and their relationship to shoulder dystocia. We conducted a retrospective cohort study and identified all neonates with brachial plexus injury delivered at our institution between March 2012 and July 2019. A review was performed of the maternal and neonatal records of each neonate to identify obstetric antecedents, including the occurrence of shoulder dystocia and persistence of the injury. Experience of the delivering clinician was also examined. Statistical analysis was performed with the Fisher exact test, χ test for trends, and two-tailed t tests. Thirty-three cases of brachial plexus injury were identified in 41,525 deliveries (0.08%). Fourteen (42%) of these cases were not associated with shoulder dystocia; three (9%) followed cesarean delivery. Brachial plexus injury without shoulder dystocia was related to the absence of maternal diabetes, lower birth weights, and a longer second stage of labor. Persistent brachial plexus injury at the time of discharge was seen with equal frequency among neonates with (17/19, 89%, 95% CI 0.52-100%) and without shoulder dystocia (10/14, 71%, 95% CI 34-100%), P=.36). Whether brachial plexus injury was transient or persistent after shoulder dystocia was unrelated to the years of experience of the delivering clinician. Despite ongoing training and simulation, the already low incidence of brachial plexus injury did not decrease over time at our institution. Brachial plexus injury and shoulder dystocia represent two complications of uterine forces driving a fetus through the maternal pelvis in the presence of disproportion between the passage and the shoulder girdle of the passenger. Either or both of these complications may occur, but often are not causally related.

Trendelenburg Position-Induced Brachial Plexus Injury Following Laparoscopic Rectal Cancer Surgery

Position-related brachial plexus injury may be diagnosed currently because of the rise in the number of laparoscopic colorectal surgeries being performed. The Trendelenburg position, which is necessary for laparoscopic and robotic surgeries, may lead to excessive pressure on the shoulders and thus cause brachial plexus injury. There are some risk factors like prolonged surgery and high BMI. Most patients recover with high-dose corticosteroid treatment and physical therapy. We report a case of brachial plexus injury caused by patient position during surgery.

Multi-level Nerve Injury of the Upper Extremity Management and Review of Brachial Plexus Literature: A Case Report

Backround: Brachial plexus injuries are complex cases requiring a thorough understanding of nerve physiology and upper extremity anatomy. Standard approaches and management have been developed but certain situations still arise where these are not feasible options. Objectives: A case of brachial plexus injury is discussed in this report. The patient was a young male who was referred to our center with weakness of the left upper extremity, C5-C7 distribution. Certain components of his injury, such as extensive soft tissue scarring and identification of a long neuroma at the injury site, obliged the surgeons to use unconventional nerve transfers during his surgery. In this paper, we discuss these alternative options in order to support their potential use in complex brachial plexus cases. Other concepts such as single fascicular harvest for nerve transfers and nerve graft augmented nerve transfers are discussed as they were successfully used in this report. Methodology and Results: The patient underwent a total of five surgeries which were a combination of nerve and tendon transfers. Some nerve transfers were augmented with long autologous nerve grafts reaching up to fifteen centimeters in length. Throughout the patients sequence of surgeries, certain nerves, such as the ulnar nerve branch to the flexor carpi ulnaris, successfully served as a donor nerve in more than one occasion. Muscle groups where single nerve fascicles were previously used as a donor nerves also yielded adequate muscle strength and were successfully subsequently used in tendon transfers. Ultimately, the patient was able to achieve good muscle strength, range of motion and outcome scores on his left upper extremity after two years from his final surgery. Conclusion: This report offers multiple alternative options in managing complex brachial plexus cases as well as challenges some concepts in nerve grafting. Alternative donor nerves are offered for transfers, some of which are not previously used in literature. Aside from this, the use of long autologous nerve grafts, single fascicular nerve transfers and repeated use of certain nerves as donor were performed successfully. We hope these procedures and techniques can be added to each hand specialist arsenal for managing complex brachial plexus injuries, specifically when the standard techniques are not feasible.

Induction of labor at 39 weeks of gestation versus expectant management for low-risk nulliparous women: a cost-effectiveness analysis

A large, recent multicenter trial found that induction of labor at 39 weeks for low-risk nulliparous women was not associated with an increased risk of cesarean delivery or adverse neonatal outcomes. We sought to examine the cost-effectiveness and outcomes associated with induction of labor at 39 weeks vs expectant management for low-risk nulliparous women in the United States. A cost-effectiveness model using TreeAge software was designed to compare outcomes in women who were induced at 39 weeks vs expectantly managed. We used a theoretical cohort of 1.6 million women, the approximate number of nulliparous term births in the United States annually that are considered low risk. Outcomes included mode of delivery, hypertensive disorders of pregnancy, macrosomia, stillbirth, permanent brachial plexus injury, and neonatal death, in addition to cost and quality-adjusted life years for both the woman and neonate. Model inputs were derived from the literature, and a cost-effectiveness threshold was set at $100,000/quality-adjusted life years. In our theoretical cohort of 1.6 million women, induction of labor resulted in 54,498 fewer cesarean deliveries and 79,152 fewer cases of hypertensive disorders of pregnancy. We also found that induction of labor resulted in 795 fewer cases of stillbirth and 11 fewer neonatal deaths, despite 86 additional cases of brachial plexus injury. Induction of labor resulted in increased costs but increased quality-adjusted life years with an incremental cost-effectiveness ratio of $87,691.91 per quality-adjusted life year. In sensitivity analysis, if the cost of induction of labor was increased by $180, elective induction would no longer be cost effective. Similarly, we found that if the rate of cesarean delivery was the same in both strategies, elective induction of labor at 39 weeks would not be a cost-effective strategy. In probabilistic sensitivity analysis via Monte Carlo simulation, we found that induction of labor was cost effective only 65% of the time. In our theoretical cohort, induction of labor in nulliparous term women at 39 weeks of gestation resulted in improved outcomes but increased costs. The incremental cost-effectiveness ratio was marginally cost effective but would lead to an additional 2 billion dollars of healthcare costs. Whether individual clinicians and healthcare systems offer routine induction of labor at 39 weeks will need to depend on local capacity, careful evaluation and allocation of healthcare resources, and patient preferences. KEY WORDS: cesarean delivery, decision analysis, healthcare resources, induction of labor, low-risk nulliparous women, mode of delivery, obstetric outcomes.

20: Induction of labor versus expectant management at 39 weeks: a cost-effectiveness analysis

A recent study found that induction of labor at 39 weeks for low-risk women was not associated with an increased risk of adverse neonatal outcomes. We sought to examine the cost-effectiveness and outcomes associated with induction of labor at 39 weeks versus expectant management. A cost-effectiveness model using TreeAge software was designed to compare outcomes in women who were induced at 39 weeks versus expectantly managed. We used a theoretical cohort of 1.6 million women, the approximate number of nulliparous term births in the US annually that are considered low risk. Outcomes included mode of delivery, preeclampsia, macrosomia, intrauterine fetal demise, permanent brachial plexus injury, cerebral palsy, and neonatal death, in addition to cost and quality-adjusted life years (QALY) for both the woman and neonate. Probabilities were derived from the literature, and a cost-effectiveness threshold was set at $100,000/QALY. In our theoretical cohort of 1.6 million women, induction of labor resulted in 49,449 fewer cesarean deliveries and 79,152 fewer cases of preeclampsia. Additionally, we found that induction of labor resulted in 795 fewer cases of intrauterine fetal demise and 49 fewer neonatal deaths, despite 50 more cases of brachial plexus injury and 54 cases of moderate cerebral palsy (Table 1). Induction of labor resulted in increased costs, but increased QALYs with an incremental cost-effectiveness ratio of $97,501 per QALY. Univariate sensitivity analysis demonstrated that induction of labor was cost-effective until the cost of induction exceeded $2000 (Figure 1). In our theoretical cohort, induction of labor in nulliparous term women at 39 weeks of gestation resulted in improved outcomes, but increased costs. The cost-effectiveness ratio was marginally cost effective, but would lead to an additional $2.26 billion of health care costs. Whether individual clinicians and healthcare systems offer routine induction of labor at 39 weeks will need to depend on local capacity and patient preferences.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Treatment experience of proximal humerus degloving fracture

To summarize a new type of proximal humerus fracture-proximal humerus degloving fracture, and discuss its injury mechanism, classification criteria, and treatment methods. The clinical data of 23 patients with proximal humerus degloving fracture between September 2009 and September 2016 was retrospectively analyzed. There were 14 males and 9 females, with an average age of 39.7 years (range, 21-66 years). The causes of injury was sprain in 2 cases, falling from height in 8 cases, and traffic accident in 13 cases. The time from injury to operation was 3-116 days (mean, 17.1 days). There were 2 cases of posterior dislocation of humeral head, 3 cases of anterior dislocation of humeral head, 3 cases of other fractures, and 2 cases of brachial plexus injury. All patients had varying degrees of rotator cuff injuries. According to the self-determined fracture classification criteria, there were 6 cases of internal rotation type, 14 cases of external rotation type, and 3 cases of abduction type. All patients underwent open reduction and internal fixation. All patients were followed up 9-24 months (mean, 17 months). All incisions healed by the first intention. X-ray films showed that all fractures healed at 3-5 months after operation (mean, 3.6 months). According to the Neer's shoulder functional evaluation criteria at 6 months, the shoulder function was rated as excellent in 16 cases, good in 5 cases, fair in 1 case, and poor in 1 case, and the excellent and good rate was 84.6%. The rotator cuff tear recurred in 1 case and was repaired again. The injury mechanism of proximal humerus degloving fracture may be the extreme internal rotation, extreme external rotation, or extreme abduction. Reduction and internal fixation is an effective treatment. The focus of the treatment is not only the fixation of the fracture, but also the repair and reconstruction of the rotator cuff.

A Case of Brachial Plexus Injury Caused by Inappropriate Body Position during Surgery

A Case of Brachial Plexus Injury Caused by Inappropriate Body Position during Surgery

PP-179 - Steroid Injection in Brachial Plexus Injury After Open Heart Surgery: Case Report

Brachial plexus injury is rare after open heart surgery and causes complaints ranging from sensory deficits to muscle loss. We published a case of brachial plexus injury after open heart surgery, in which we applied lidocaine and triamcinolone acetonide injection to the surrounding tissue of the brachial plexus.

Brachial Plexus Injuries with Ulnar Musculocutaneous Transfer: 78 Cases Study Focused on Possible Postoperative Complications

Objective To analyze 78 cases of brachial plexus injury submitted to the Oberlin technique between 2003 and 2012. The potential complications of this technique were analyzed, especially motor damage or hypoesthesia of the hand. Method Medical records from patients with brachial plexus injuries at the levels of the C5-C6 and C5-C6-C7 vertebrae were retrospectively analyzed. Cases submitted to the Oberlin procedure with or without concomitant brachial plexus procedures between 2003 and 2012 were evaluated. The minimum follow-up period was of 1 year. In addition to the clinical examination, electromyography and magnetic resonance imaging (MRI) of the brachial plexus were used to diagnose and locate the nerve damage. Results A total of 78 surgical patients met the inclusion criteria. Postoperative neurological changes, mostly transient, were observed in 18 patients. Hypoesthesia in the ulnar side of the hand was observed in seven cases; neuropathic pain in five cases; allodynia in four cases, and hand motor loss in two cases. Conclusion Based on the results of the present case series, we conclude that there are few sequelae in the donor nerve territory compared with the benefit of the Oberlin technique on the recovery of elbow flexion after brachial plexus injuries.

Six-year incidence and some features of cases of brachial plexus injury in a tertiary referral center.

Objective:To present some features and incidence of cases of brachial plexus injury in deliveries at the Department of Obstetrics and Gynecology of Zeynep Kamil Maternity and Children’s Training and Research Hospital, from January 2010 through December 2014.Materials and Methods:In total, 38.896 deliveries in the Department of Obstetrics and Gynecology of Zeynep Kamil Maternity and Children’s Training and Research Hospital, from January 2010 through December 2014 were screened from a prospectively collected database. We recorded gravidity, parity, body mass index, maternal diabetes, labor induction, gestational age at delivery, operative deliveries, malpresentations, prolonged second stage of deliveries, shoulder dystocies, clavicle and humerus fructures, estimated fetal weight, biparietal diameter, abdominal circumference, femur length, fetal sex, route of delivery, maternal age, and fetal anomalies.Results:There were 28 (72/100.000) cases of brachial plexus injury among 38.896 deliveries. In the 6-year study period, there were 18.363 deliveries via c-section, whereas 20.533 were vaginal deliveries.Conclusion:Sonographic fetal weight estimation and clinical examination performed by experienced obstetricians, and active appropriate management of shoulder dystocias seemed to attenuate the incidence of brachial plexus injury in the at risk population in our tertiary referral center.

Prevention of brachial plexus injury-12years of shoulder dystocia training: an interrupted time-series study.

To investigate management and outcomes of incidences of shoulder dystocia in the 12years following the introduction of an obstetric emergencies training programme. Interrupted time-series study comparing management and neonatal outcome of births complicated by shoulder dystocia over three 4-year periods: (i) Pre-training (1996-99), (ii) Early training (2001-04), and (iii) Late training (2009-12). Southmead Hospital, Bristol, UK, with approximately 6000 births per annum. Infants and their mothers who experienced shoulder dystocia. A bi-monthly multi-professional 1-day intrapartum emergencies training course, that included a 30-minute practical session on shoulder dystocia management, commenced in 2000. Neonatal morbidity (brachial plexus injury, humeral fracture, clavicular fracture, 5-minute Apgar score <7) and documented management of shoulder dystocia (resolution manoeuvres performed, traction applied, head-to-body delivery interval). Compliance with national guidance improved with continued training. At least one recognised resolution manoeuvre was used in 99.8% (561/562) of cases of shoulder dystocia in the late training period, demonstrating a continued improvement from 46.3% (150/324, P<0.001) pre-training, and 92% (241/262, P<0.001) in the early training period. In parallel there was reduction in the brachial plexus injury at birth (24/324 [7.4%, P<0.01], pre-training, 6/262 [2.3%] early training, and 7/562 [1.3%] late training. There are significant benefits to long-term, embedded training programmes with improvements in both management and outcomes. A decade after the introduction of training there were no cases of brachial plexus injury lasting over 12months in 562 cases of shoulder dystocia.

Are there modifiable risk factors that may predict the occurrence of brachial plexus injury?

To identify risk factors, particularly modifiable, associated with brachial plexus injury. A retrospective case-control study conducted at a single hospital between the years 1993 and 2012. All neonates who were diagnosed of brachial plexus injury were included. A control group matched at a ratio of 1:2 was randomly selected. Demographic and obstetric data were obtained from the hospital discharge register with ICD-9 codes and crosschecked with the labor medical records. All medical files were manually checked and validated. A stepwise logistic regression model was performed to identify independent predictors for brachial plexus injury before delivery among those found significant in the univariate analysis. Of all 83 806 deliveries that took place during this period, 144 cases of brachial plexus injury were identified (1.7/1000 deliveries). Overall, 142 cases and 286 controls had available data. Among the study group, 41 (28.9%) had documented shoulder dystocia compared with 1 (0.4%) among the controls (P<0.0001). Logistic regression analysis revealed that maternal age above 35 years (P=0.01; odds ratio (OR) 2.7; 95% confidence interval (CI) 1.3 to 5.7), estimated fetal weight before delivery (P<0.0001; OR 2.5; 95% CI 1.7 to 3.8, for each 500 g increase), vaginal birth after cesarean (P=0.02; OR 3.3; 95% CI 1.2 to 8.8) and vacuum extraction (P=0.02; OR 3.6; 95% CI 1.2 to 10.3) were all found to be independent predictors for developing brachial plexus injury. When stratifying the analysis according to parity, vacuum delivery was found to be an independent risk factor only among primiparous women (OR 6.0; 95% CI 1.7 to 21.6). The findings suggest that very few factors contributing to brachial plexus injury are modifiable. For that reason, it remains an unpredictable and probably an unavoidable event.

Long-term results of intercostal nerve transfer to triceps branch of the radial nerve

Objective To evaluate the long-term outcomes of restoring elbow extension by transferring intercostal nerves to the triceps branch of the radial nerve. Methods A retrospective study of 23 cases of brachial plexus injuries treated with intercostal nerve transfer to the triceps branch of the radial nerve at our hospital between 2004 and 2008 was conducted. Recovery of triceps muscle power and elbow extension was analyzed. Among these patients 16 had complete brachial plexus root avulsions while 7 had C5 to C7 root avulsions with lower tnmk non-avulsion lesions. The mean duration between injury and intercostal nerve transfer was 5.7 months. The mean follow-up time was 48.7 months. Results Good or excellent motor recovery of the triceps （muscle power over M3） was achieved in 39.1% of the patients. Triceps strength recovered to M2 in 30.4% of the patients and to M1 or lower in 30.5% of the patients. Patients with C5 to C7 root avulsion along with C,s to TI traction had better recovery than those with complete brachial plexus root avulsions. There was no significant difference in treatment outcomes when 2 or more than 2 intercostal nerves were used for neurotization. Conclusion Intercostal nerves transfer to the triceps branch of the radial nerve can restore triceps function to ~me extent. Key words: Brachial plexus; Intercostal nerve; Follow-up studies; Triceps branch; Nervetransfer