Treatment Of Brachial Plexus Injuries Research Articles

Contralateral C7 transfer combined with acellular nerve allografts seeded with differentiated adipose stem cells for repairing upper brachial plexus injury in rats.

Nerve grafting has always been necessary when the contralateral C7 nerve root is transferred to treat brachial plexus injury. Acellular nerve allograft is a promising alternative for the treatment of nerve defects, and results were improved by grafts laden with differentiated adipose stem cells. However, use of these tissue-engineered nerve grafts has not been reported for the treatment of brachial plexus injury. The aim of the present study was to evaluate the outcome of acellular nerve allografts seeded with differentiated adipose stem cells to improve nerve regeneration in a rat model in which the contralateral C7 nerve was transferred to repair an upper brachial plexus injury. Differentiated adipose stem cells were obtained from Sprague-Dawley rats and transdifferentiated into a Schwann cell-like phenotype. Acellular nerve allografts were prepared from 15-mm bilateral sections of rat sciatic nerves. Rats were randomly divided into three groups: acellular nerve allograft, acellular nerve allograft + differentiated adipose stem cells, and autograft. The upper brachial plexus injury model was established by traction applied away from the intervertebral foramen with micro-hemostat forceps. Acellular nerve allografts with or without seeded cells were used to bridge the gap between the contralateral C7 nerve root and C5-6 nerve. Histological staining, electrophysiology, and neurological function tests were used to evaluate the effect of nerve repair 16 weeks after surgery. Results showed that the onset of discernible functional recovery occurred earlier in the autograft group first, followed by the acellular nerve allograft + differentiated adipose stem cells group, and then the acellular nerve allograft group; moreover, there was a significant difference between autograft and acellular nerve allograft groups. Compared with the acellular nerve allograft group, compound muscle action potential, motor conduction velocity, positivity for neurofilament and S100, diameter of regenerating axons, myelin sheath thickness, and density of myelinated fibers were remarkably increased in autograft and acellular nerve allograft + differentiated adipose stem cells groups. These findings confirm that acellular nerve allografts seeded with differentiated adipose stem cells effectively promoted nerve repair after brachial plexus injuries, and the effect was better than that of acellular nerve repair alone. This study was approved by the Animal Ethics Committee of the First Affiliated Hospital of Sun Yat-sen University of China (approval No. 2016-150) in June 2016.

Brachial Plexus Injuries in Adults: Guidelines and Management in our Experience

According to the data published in current medical literatures, brachial plexus injuries affect slightly more than 1 % of multi-trauma patients. Motorcycle accidents were the leading cause associated with the occurrence of these lesions that often lead to severe disability mostly in young individuals. The vast majority of these patients were young males between 15 and 35 years. After the injury, approximately 95% of these patients suffer from excruciating pain that poses an additional burden on the quality of life, already disrupted by the functional impairment of the upper limb. Despite the statistical rarity, brachial plexus injuries clearly have a remarkable impact on the community. Today with new techniques in the role of surgical procedures, the quality of life of many of these patients can be improved especially in partial lesions allowing functional recovery, rescuing these young individuals from disability and improving their lifestyle. Early diagnostic assessment with prompt referral to the surgeon is crucial to obtain a positive outcome. Physiotherapy plays a vital role in the rehabilitation process. The Author aims to illustrate guidelines in the management and surgical treatment of brachial plexus injuries as gained in over 20 years of experience in medical practice.

The zonal pattern of arterial supply to the brachial plexus and its clinical significance.

To provide the anatomical basis of blood supply of brachial plexus for the clinical microsurgical treatment of brachial plexus injury. Thirteen adult anticorrosive cadaveric specimens (8 males, 5 females) were dissected in this study. 3 fresh cases (2 males, 1 female) were used to observe the zonal pattern of arteries supplying brachial plexus, and 10 cases (6 males, 4 females) were used to observe the source and distribution of the brachial plexus arteries under microscope. The brachial plexus is supplied by branches of the subclavian-axillary axis (SAA), and these branches anastomose each other. According to distribution feature, blood supply of the brachial plexus could be divided into three zones. The first zone was from the nerve roots of intervertebral foramina to its proximal trunks, which was supplied by the vertebral artery and the deep cervical artery. The second zone was from the distal nerve trunks of the brachial plexus, encompassing the divisions to its proximal cords, which was supplied by direct branches of the subclavian artery or by branches originating from the dorsal scapular artery. The third zone was from the distal portion of the cords to terminal branches of the brachial plexus, which was supplied by direct branches of the axillary artery. The zonal pattern of arterial supply to the brachial plexus is a systematic and comprehensive modality to improve anatomical basis for the clinical microsurgical treatment for brachial plexus injury.

Five Operations That Give the Best Results after Brachial Plexus Injury.

Treatment of brachial plexus injuries has improved slowly over the past 45 years. Changes in strategy, techniques, microsurgical equipment, and technology have expanded the surgical options for reconstructing these life-altering, highly complex injuries. The surgical techniques available include neurolysis, nerve repair, nerve grafting, nerve transfers, tendon transfer, muscle transfer, and other soft- and bony-tissue procedures. In this article, the authors have selected five surgical procedures (i.e., Oberlin procedure, Leechavengvongs procedure, free functional muscle transfer, radial nerve tendon transfers, and C5-C6 nerve grafting in obstetric birth palsy) that have consistently yielded good results in patients who require surgical reconstruction.

Results of Operative Treatment of Brachial Plexus Injury Resulting from Shoulder Dislocation: A Study with A Long-Term Follow-Up.

Injury to the infraclavicular brachial plexus is an uncommon but serious complication of shoulder dislocation. This work aims to determine the effectiveness of operative treatment in patients with this type of injury. Thirty-three patients (26 men and 7 women; mean age, 45 years and 3 months) treated operatively for brachial plexus injury resulting from shoulder dislocation between the years 2000 and 2013 were included in this retrospective case series. Motor function of affected limbs was assessed pre- and postoperatively with the use of the British Medical Research Council (BMRC) scale. Sensory function in the areas innervated by ulnar and median nerves was evaluated with the BMRC scale modified by Omer and Dellon and in the remaining areas with the Highet classification. Follow-up lasted 2-10 years (mean, 5.1 years). Good postoperative recovery of nerve function was observed in 100% of musculocutaneous, 93.3% of radial, 66.7% of median, 64% of axillary, and 50% of ulnar nerve injuries. No recovery was observed in 5.6% of median, 6.7% of radial, 10% of ulnar, and 20% of axillary nerve injuries. Injury to a single nerve was associated with worse treatment outcome than multiple nerve injury. Obtaining improvement in peripheral nerve function after injury resulting from shoulder dislocation may require operative intervention. The type of surgical procedure depends on intraoperative findings: sural nerve grafting in cases of neural elements' disruption, internal neurolysis when intraneural fibrosis is observed, and external neurolysis in the remaining cases. The outcomes of surgical treatment are good, and the risk of intra- and postoperative complications is low.

The Effects of Minocycline on Spinal Root Avulsion Injury in Rat Model.

The neuroprotective role of minocycline in the treatment of brachial plexus injury is controversial. To study the neuroprotective effect of minocycline via different routes in adult Sprague Dawley rats with brachial plexus injury. The C7 nerve roots of the animals were avulsed via an anterior extravertebral approach. Traction force was used to transect the ventral motor nerve roots at the preganglionic level. Intraperitoneal and intrathecal minocycline (50 mg/kg for the first week and 25 mg/kg for the second week) were administered to promote motor healing. The spinal cord was harvested six weeks after the injury, and structural changes following the avulsion injury and pharmacological intervention were analysed. Motor neuron death and microglial proliferation were observed after the administration of minocycline via two different routes (intraperitoneal and intrathecal) following traumatic avulsion injury of the ventral nerve root. The administration of intraperitoneal minocycline reduced the microglia count but increased the motor neuron count. Intrathecal minocycline also reduced the microglial count, with a greater reduction than in the intraperitoneal group, but it decreased the motor neuron count. Intraperitoneal minocycline increased motor neuron survival by inhibiting microglial proliferation following traumatic avulsion injury of the nerve root. The inhibitory effect was augmented by the use of intrathecal minocycline, in which the targeted drug delivery method increased the bioavailability of the therapeutic agent. However, motor neuron survival was impaired at a higher concentration of minocycline via the intrathecal route due to the more efficient method of drug delivery. Microglial suppression via minocycline can have both beneficial and damaging effects, with a moderate dose being beneficial as regards motor neuron survival but a higher dose proving neurotoxic due to impairment of the glial response and Wallerian degeneration, which is a pre-requisite for regeneration.

Abstract: Single and Double Reinnervation of the Gastrocnemius Muscle in Rats - Experimental Model

INTRODUCTION: Muscle contraction generated by electrical impulses originated simultaneously from two different neural sources may be an interesting alternative for facial palsy and brachial plexus injury treatment.1–4 We hypothesized that double reinnervation leads to better muscle functional recovery. Thus, an experimental model was created to assess double and single muscle reinnervation of the gastrocnemius muscle in rats.

Método Chordata combinado com eletroterapia na recuperação funcional após lesão do plexo braquial: relato de três casos clínicos

Aims: To report three clinical cases of complex brachial plexus injury treated with an innovative physical therapy program, the Chordata Method, combined with electrotherapy. Case description: Three patients suffered a complex brachial plexus injury. They were submitted to surgery and to long-term rehabilitation with the Chordata method (including suspension and tilting exercises) combined with electrotherapy. All patients exhibited significant signs of recovery in post-treatment electroneuromyography. Moreover, improvements in muscle strength and in the range of motion of the injured upper limb were also observed, leading to better posture and gains in activities of daily living (e.g., driving a modified car, holding objects, performing household chores, and doing leisure activities). Conclusions: There was great functional recovery after the physical therapy program with the Chordata Method combined with electrotherapy, with an impact on patients’ daily lives as well as on electroneuromyography findings. Randomized clinical trials are needed to confirm or refute this new non-pharmacological strategy for the treatment of brachial plexus injuries.

Obstetric brachial plexus injuries and treatment between 0-2 years of age and #8232;

Obstetrical brachial plexus injury treatment was debatable before 1980. In the last three decades, however, treatment options and techniques are progressed. With successful results increasing the overall success rate, today, treatment of these patients is routinely performed in many countries, including Turkey, since 1993. Surgical treatment of brachial plexus injuries is still progressing in correlation with nerve injury treatments, but there are still obstacles related to treatment of multiple root avulsions and restoring hand function. In general, when treating an injury is difficult, it is always better to take care to prevent it. This may be possible with education of the population, patients, doctors and the government. In this article, differential diagnosis, radiological examination and conservative and surgical treatment of obstetrical brachial plexus injuries in the first two years of the age are discussed.

Adult brachial plexus injuries: Surgical strategies and approaches.

Traumatic brachial plexus injuries are devastating injuries commonly affecting the young population and leading to significant socioeconomic losses to the society. The results of brachial plexus surgery have been severely disappointing in the past. However, several technological advancements and newer surgical techniques, especially the advent of distal nerve transfers over recent years, have led to a paradigm shift in the outcome of patients with these injuries. The best time window for surgery is the first 3 months after injury, and the next best time is the next 3 months. The timing is a crucial factor as the neuromuscular junctions degenerate in 20-24 months. The presence of spontaneous fibrillations in a muscle on electromyography is an indication of denervated yet vital muscle. The restoration of elbow flexion is a priority followed closely by restoration of shoulder abduction and stabilization. The various surgical strategies in brachial plexus injuries should be directed toward accomplishing this goal. The global avulsion injuries have a poor outcome because of very limited source of donors in such types of injury whereas the partial injuries have a remarkable outcome in a majority of cases. This article presents the reader with the guidelines and management algorithms of repair strategy and various surgical approaches utilized in the surgical treatment of brachial plexus injuries.

Dennervated SBRN versus Sural Nerve Grafting: A Case-control Analysis of 75 Patients: Level 3 Evidence

Salary: Mayo Clinic (Shin)Royalty: Trimed (Shin)Contracted Research: Bacterin International (Shin)Other (Please describe): editor Techniques Hand Upper Extremity (Shin) The purpose of our study was to perform a case-control analysis of two sources of nerve graft; the denervated superficial branch of the radial nerve (SBRN) in patients with ipsilateral brachial plexus injuries and the normal sural nerve in nerve grafting to restore function in the upper extremity. Over a 10-year period, 25 patients underwent SBRN nerve grafting with a dennervated ipsilateral nerve for brachial plexus injuries, which were T matched 2:1 with 50 patients who underwent sural nerve grafting by age, gender, and BMI (Comparisons are summarized in Table 1). The average follow-up for the use of ipsilateral dennervated SBRN patients was 2.5 years (1-7) and for the sural patients was 2.8 years (1-9). In the dennervated SBRN group, only 3 (12%) of patients experienced grade III or higher muscle function. All 3 of these patients underwent a grafting of the spinal accessory to triceps motor branch. This is in contrast to 20 (36%) of the patients who underwent sural nerve grafting achieving grade III or higher muscle recovery (P < 0.01), including C5, C6, or upper trunk to axillary (n=5) and musculocutaneous (n=7); or spinal accessory to axillary (n=1), musculocutaneous (n=2), and triceps motor branch (n=5). Only 12% of the dennervated SBRN group had EMG signs of muscle recovery compared to 61% of the sural nerve group (P < 0.01). Smoking had a negative impact on muscle recovery, decreasing the rate of grade III or higher recovery in the dennervated SBRN group (P < 0.01) and the sural group (P = 0.01). No other factors had an impact on muscle recovery. Overall, patients in both groups had significant improvements in their preoperative to postoperative pain and DASH scores (P < 0.04). •Use of ipsilateral dennervevated SBRN nerve grafts in patietns with brachial plexus injures has significantly poorer outcomes when compared to sural nerve grafts in the treatment of brachial plexus injuries in a matched series.•The use of this deinnervated nerve should be saved for situations when no other nerves grafts are available and should be avoided when sural nerve grafts are available.•Patients also should be counseled on the risks of smoking when choosing to undergo brachial plexus reconstruction.

Nerve transfers of the forearm and hand: a review of current indications

Nerve transfer surgery, also referred to neurotization, developed in the mid 1800s with the use of animal models, and was later applied in the treatment of brachial plexus injuries. Neurotization is based on the concept that following a proximal nerve lesion with a poor prognosis, expendable motor or sensory nerves can be re-directed in proximity of a specific target, whether a muscle or skin territory, in order to obtain faster re-innervation. Thanks to the contribution of several authors including Oberlin, MacKinnon and many others, the field of nerve transfer surgery has expanded in treatment of not only the brachial plexus, but also the arm, forearm and hand. This article reviews the recent literature regarding current concepts in nerve transfer surgery, including similarities to and differences from tendon transfer surgery. Moreover, indications and surgical techniques are illustrated for different types of nerve injury affecting the extrinsic and intrinsic musculature of the hand as well as sensory function.

Transfer of the brachialis to the anterior interosseous nerve as a treatment strategy for cervical spinal cord injury: technical note.

Study Design Technical report. Objective To provide a technical description of the transfer of the brachialis to the anterior interosseous nerve (AIN) for the treatment of tetraplegia after a cervical spinal cord injury (SCI). Methods In this technical report, the authors present a case illustration of an ideal surgical candidate for a brachialis-to-AIN transfer: a 21-year-old patient with a complete C7 spinal cord injury and failure of any hand motor recovery. The authors provide detailed description including images and video showing how to perform the brachialis-to-AIN transfer. Results The brachialis nerve and AIN fascicles can be successfully isolated using visual inspection and motor mapping. Then, careful dissection and microsurgical coaptation can be used for a successful anterior interosseous reinnervation. Conclusion The nerve transfer techniques for reinnervation have been described predominantly for the treatment of brachial plexus injuries. The majority of the nerve transfer techniques have focused on the upper brachial plexus or distal nerves of the lower brachial plexus. More recently, nerve transfers have reemerged as a potential reinnervation strategy for select patients with cervical SCI. The brachialis-to-AIN transfer technique offers a potential means for restoration of intrinsic hand function in patients with SCI.

A Systematic Review of Outcomes Reporting for Brachial Plexus Reconstruction

To better understand the manner in which outcomes are reported after brachial plexus reconstruction, we conducted a systematic review of the scientific literature. We included English-language articles describing treatment of brachial plexus injuries to restore motor function of the shoulder, elbow, forearm, and/or wrist with nerve repair, nerve graft, and/or nerve transfer. We recorded the anatomical location of injury, the treatment used, and the manner in which motor function, active and passive range of motion, pain, quality of life, function or disability, patient satisfaction, and psychosocial health was reported. In reviewing 88 papers with outcomes for 5,189 patients, 83 (94%) of the papers reported postoperative motor function. Of these, 49 (59%) did not include any other measures of patient outcome. Active range of motion was reported in 24 (27%) studies, pain was reported in 15 (17%) studies, quality of life was reported in 4 (5%) studies, function or disability was reported in 5 (6%) studies, patient satisfaction in 3 (3%) studies, and psychosocial health in 1 study. To date, outcome reporting for brachial plexus surgery has largely centered on motor recovery and typically has not included measures of function or nonmusculoskeletal recovery. Incorporating currently used measures of physical recovery with patient-derived outcomes measures such as quality of life, function, pain, and satisfaction will likely help provide a more comprehensive understanding of the effect of brachial plexus reconstruction surgery. Diagnostic III.

Platysma motor branch transfer in brachial plexus repair: report of the first case

BackgroundNerve transfers are commonly employed in the treatment of brachial plexus injuries. We report the use of a new donor for transfer, the platysma motor branch.MethodsA patient with complete avulsion of the brachial plexus and phrenic nerve paralysis had the suprascapular nerve neurotized by the accessory nerve, half of the hypoglossal nerve transferred to the musculocutaneous nerve, and the platysma motor branch connected to the medial pectoral nerve.ResultsThe diameter of both the platysma motor branch and the medial pectoral nerve was around 2 mm. Eight years after surgery, the patient recovered 45° of abduction. Elbow flexion and shoulder adduction were rated as M4, according to the BMC. There was no deficit after the use of the above-mentioned nerves for transfer. Volitional control was acquired for independent function of elbow flexion and shoulder adduction.ConclusionThe use of the platysma motor branch seems promising. This nerve is expendable; its section led to no deficits, and the relearning of motor control was not complicated. Further anatomical and clinical studies would help to clarify and confirm the usefulness of the platysma motor branch as a donor for nerve transfer.

Functioning transferred free muscle innervated by part of the vascularized ulnar nerve connecting the contralateral cervical seventh root to themedian nerve: Case report

BackgroundThe limited nerve sources available for the reconstruction and restoration of upper extremity function is the biggest obstacle in the treatment of brachial plexus injury (BPI). We used part of a transplanted vascularized ulnar nerve as a motor source of a free muscle graft.Case presentationA 21-year-old man with a left total brachial plexus injury had received surgical intercostal nerve transfer to the musculocutaneous nerve and a spinal accessory nerve transfer to the suprascapular nerve in another hospital previously. He received transplantation of a free vascularized gracilis muscle, innervated by a part of the transplanted vascularized ulnar nerve connecting the contralateral healthy cervical seventh nerve root (CC7) to the median nerve, and recovered wrist motion and sensation in the palm. At the final examination, the affected wrist could be flexed dorsally by the transplanted muscle, and touch sensation had recovered up to the base of each finger. When his left index and middle fingers were touched or scrubbed, he felt just a mild tingling pain in his right middle fingertip.ConclusionPart of the transplanted vascularized ulnar nerve connected to the contralateral healthy cervical seventh nerve root can be used successfully as a motor source and may be available in the treatment of patients with BPI with scanty motor sources.

Bed wise cost analysis of in-patient treatment of brachial plexus injury at a Level I trauma Center in India.

Aim:The aim was to calculate, in monetary terms, total cost incurred by a Level I trauma center in providing in-patient care to brachial plexus injury patients during their preoperative and the postoperative stay.Subjects and Methods:All patients of brachial plexus injury admitted and discharged between January and December 2010 were included in the study. Total cost per bed was calculated under several cost heads in pre- and post-operative ward care. Intra-operative costs were excluded.Results:A total of 69 patients were admitted in the year 2010. Of these 60 were operated and the rest were planned conservative management. The total cost incurred by the trauma center in providing in-patient care to patients admitted in the ward, excluding high dependency unit, came out to be Rs. 3,650.00/patient/bed/day. Of this Rs. 2,234.645, the maximum amount was incurred in providing manpower alone. The average preoperative wait was 12 days (maximum 41 days and minimum 1-day). The average postoperative stay was 2 days. Total cost incurred in the preoperative period was Rs. 2,975,125 (US$ 59392) or Rs. 43,117/patient (US$ 861). It was Rs. 386,948 (US$ 7724) in the postoperative period (Rs. 6,449 or US$ 129/patient). Nine patients were not operated and had waited from 2 to 12 days before finally being planned for observant treatment. This itself cost the hospital Rs. 226,328 (US$ 4518).Conclusion:By just reducing the preoperative length of stay to 1-day the cost can be brought down by 93% for brachial plexus injury patients alone and the beds can be used to admit more critical patients.

Nerve transfer helps repair brachial plexus injury by increasing cerebral cortical plasticity

In the treatment of brachial plexus injury, nerves that are functionally less important are transferred onto the distal ends of damaged crucial nerves to help recover neuromuscular function in the target region. For example, intercostal nerves are transferred onto axillary nerves, and accessory nerves are transferred onto suprascapular nerves, the phrenic nerve is transferred onto the musculocutaneous nerves, and the contralateral C7 nerve is transferred onto the median or radial nerves. Nerve transfer has become a major method for reconstructing the brachial plexus after avulsion injury. Many experiments have shown that nerve transfers for treatment of brachial plexus injury can help reconstruct cerebral cortical function and increase cortical plasticity. In this review article, we summarize the recent progress in the use of diverse nerve transfer methods for the repair of brachial plexus injury, and we discuss the impact of nerve transfer on cerebral cortical plasticity after brachial plexus injury.

Clinical Outcomes after a Modified End-to-Side Nerve Transfer Using the Phrenic Nerve as a Donor for Treatment of Brachial Plexus Injury

INTRODUCTION: End-to-side neurorrhaphy has not been widely utilized due to its potentially low sprouting capability. The phrenic nerve has a continuous firing rhythm that likely enhances side sprouting.1–4 Satisfactory clinical outcomes were obtained after end-to-side neurorrhaphy with the phrenic nerve as a donor for treatment of brachial plexus injury. METHODS: A total of 86 patients (27 adults, 59 children) from 1999 to 2010 with brachial plexus injury underwent modified end-to-side phrenic neurorrhaphy by the senior author (H.S.M). For this, the phrenic side was widely opened; one or two nerve grafts were interpositioned and sutured between the phrenic nerve side and the recipient nerve end. These transfers included various recipient nerve ends (targeting end muscles with ≤ grade 1 strength): musculocutaneous nerve, anterior or posterior division of the upper trunk, axillary nerve, suprascapular nerve, etc. Post operative muscle strength was then scored using the Medical Research Council (MRC) scale, and the greatest target end muscle score was utilized. The pediatric population was specifically followed for major complications such as those requiring immediate operative management or respiratory distress. RESULTS: The patients were followed postoperatively from 3 months to 69 months (mean 25.5 months). Sixty-seven had adequate clinical records for evaluation. 23/67 (34%) patients had MRC muscle grade 4; 26/67 (39%) patients had muscle grade 3; 10/67 (15%) patients had muscle grade 2; 8/67 (12%) patients had muscle grade 1. The total effective functional recovery (≥ MRC grade 3) has reached 73%. No major complications were noted during the postoperative period in the pediatric cohort. CONCLUSION: The phrenic nerve has strong side sprouting capability suitable for end-to-side nerve repair. This is likely due to its continuous firing rhythm. Satisfactory functional results may be obtained if the phrenic nerve side is widely opened to allow nerve grafting via an oblique end-to-side repair method for brachial plexus injury treatment.This technique should be considered in severe cases with limited donor options.

The Effectiveness of Contralateral C7 Nerve Root Transfer for the Repair of Avulsed C7 Nerve Root in Total Brachial Plexus Injury: An Experimental Study in Rats

The aim of this study was to evaluate the feasibility and effectiveness of transferring the contralateral C7 root to repair avulsed C7 nerve root. Thirty rats were randomized into three groups. In group A, rats underwent whole-root avulsion of the left brachial plexus and contralateral C7 root transfer to the avulsed C7 nerve root. In group B, rats underwent whole-root avulsion and contralateral C7 root transfer to the radial nerve. In group C, rats underwent whole-root avulsion of the left brachial plexus without nerve transfer. Functional outcomes were measured by electrophysiological studies, muscle tetanus contraction force, muscle mass, and histology. Six months postoperatively, increased amplitude and shortened latency of compound muscle action potentials, larger maximum tetanic contractile tension, heavier muscle mass, and larger cross-sectional area of the muscle fibers were observed in the triceps, extensor carpi radialis brevis, and extensor digitorum in groups A and B when compared with group C (p < 0.01). There were no significant differences between group A and B (p > 0.05). Contralateral C7 nerve transfer to repair avulsed C7 nerve root was feasible and effective in this rat model. It should be considered as an option for the treatment of brachial plexus injuries.