Nerve Transfer Techniques in Brachial Plexus Rehabilitation

Traumatic lesions of the brachial plexus result in profound deficits of shoulder stability, elbow flexion and hand function. Nerve transfer procedures have become central to surgical reconstruction, exploiting the principle that donor nerves with redundant or less critical functions can be re‐routed to denervated targets. Common donor sources include the spinal accessory nerve, intercostal nerves, fascicles of the ulnar or median nerves and, in selected cases, the contralateral C7 root. Successful reinnervation relies on precise anatomical mapping, timely surgery (typically within six months of injury), microsurgical coaptation close to the motor entry points and postoperative rehabilitation to encourage cortical remapping. Advances in intraoperative nerve stimulation, refined exposure techniques and adjunctive free functioning muscle transfers have broadened the therapeutic arsenal, improving outcomes in both partial and global plexus palsies.

Research from Nature Portfolio

Detailed cadaveric studies have clarified the branching patterns and fibre counts of the axillary and radial nerve divisions, revealing consistent innervation of the clavicular and acromial deltoid by the anterior axillary division, and identifying the medial and long head branches of the radial nerve as optimal donors for deltoid reinnervation. These data support targeted nerve transfers that restore shoulder abduction in up to 86% of cases and preserve donor motor function.

In global plexus injuries, free gracilis muscle transfers using the spinal accessory nerve as a donor have demonstrated satisfactory restoration of elbow flexion and wrist extension. Long-term follow-up indicates that over one third of patients achieve good elbow flexion, with acceptable wrist motion and quality-of-life scores. Complications such as vessel thrombosis and muscle bowstringing are manageable, confirming this approach as a robust option when native targets are absent.

Nerve Transfer Techniques in Brachial Plexus Rehabilitation publication trend

The graph below shows the total number of articles in nerve transfer techniques in brachial plexus rehabilitation across all publications each year (not limited to Nature Index journals).

Technical terms

Nerve transfer: Surgical rerouting of a functioning donor nerve or fascicle to a denervated recipient nerve to restore motor or sensory function.

Oberlin transfer: Partial transfer of an ulnar nerve fascicle to the biceps motor branch to reanimate elbow flexion.

Suprascapular nerve transfer: Coaptation of a donor nerve (commonly spinal accessory) to the suprascapular nerve to recover shoulder abduction and external rotation.

Axillary nerve: Brachial plexus branch innervating the deltoid and teres minor muscles, essential for shoulder motion.

Free functioning muscle transfer: Transplantation of a muscle (e.g. gracilis) with its neurovascular bundle, reinnervated by a donor nerve, to restore lost function in cases of extensive nerve injury.

References

1. Anatomical considerations for nerve transfer in axillary nerve injury. Scientific Reports (2024).
2. Results of spinal accessory to suprascapular nerve transfer in 110 patients with complete palsy of the brachial plexus.. Journal of Neurosurgery Spine (2016).
3. Functional outcome of nerve transfer for restoration of shoulder and elbow function in upper brachial plexus injury*. Journal of Brachial Plexus and Peripheral Nerve Injury (2014).
4. Results and current approach for Brachial Plexus reconstruction*. Journal of Brachial Plexus and Peripheral Nerve Injury (2014).
5. Functioning free gracilis transfer to reconstruct elbow flexion and quality of life in global brachial plexus injured patients. Scientific Reports (2016).
6. Comparison between partial ulnar and intercostal nerve transfers for reconstructing elbow flexion in patients with upper brachial plexus injuries*. Journal of Brachial Plexus and Peripheral Nerve Injury (2014).