Nerve Transfers for Brachial Plexus and Upper Extremity Nerve Injuries

Nerve transfer in the setting of both brachial plexus injury (BPI) and peripheral nerve injury (PNI) has become a valuable tool in the armamentarium of the hand and upper extremity surgeon. Depending on the level of injury, numerous donor nerves exist which can be utilized to re-animate deficient motor functions and/or restore sensation. Commonly after BPI, the patient is left with deficiencies in shoulder abduction, external rotation and/or elbow flexion/extension for which there are a host of available nerve transfer options. Unfortunately, we do not yet have many successful techniques to restore intrinsic hand function after complete BPI, however there are numerous techniques to improve hand function in the setting of PNI. Multiple donors are often available, and the decision for which to harvest is at the discretion of the surgeon, taking into consideration the presence of concomitant injury, regenerative distance and deficits which may result from donor harvest. For the best chance at an optimal outcome after nerve transfer, progressive rehabilitation programs for both motor and sensory re-education are critical. Multiple techniques for restoration of motor and sensory function after BPI and PNI are described below, as well as a description of typical rehabilitation protocol after nerve transfer.