American Association for Hand Surgery
Theme: Beyond Innovation

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Sensory and Bimanual Hand Function after Distal Nerve Transfers in the Upper Trunk Neonatal Brachial Plexus Injury Population
Kathleen M O'Grady, BScOT MSC; K. Ming Chan, MD; Michael Morhart, MD; Joe Watt, MD; Jaret Olson, MD
University of Alberta, Edmonton, AB, Canada

Introduction
In children with Erb's palsy, their shoulder and elbow movements can be severely affected. For many decades, neuroma excision and interpositional sural nerve graft repair has been the gold standard. More recently, distal nerve transfers are increasingly advocated because it carries the advantage of markedly reducing the distance of regeneration. However, there are concerns that by removing the proximal nerve stump, the sensory function of the hand after distal nerve transfers could be compromised. Given the vital role that sensory innervation plays in hand function, this question is of critical importance. Therefore, the goal of this study is to determine sensory function in the hand after distal nerve transfers in children with upper trunk neonatal brachial plexus injury.

Materials and Methods
In this prospective cohort study, 10 children who underwent distal nerve transfers were assessed with Semmes Weinstein monofilament test in 8 palmar areas of the hand to evaluate sensation to pressure. In addition, tactile perception stereo gnosis to determine their ability to manipulate small objects was also tested. Lastly, their functional hand use for bimanual hand performance was tested using the Assisting Hand Assessment.

Results
Eight out of 10 children reported normal pressure sensation with monofilament testing. Five of 10 children could identify all 10 items without sight with tactile perception testing while 1 was able to identify 9 objects, 3 eight objects and 1 six objects. The group average score on the AHA was quite high at 81 3.5 (out of 100) logit-based AHA units.

Conclusion: Children who receive a triple nerve transfer for upper trunk obstetric brachial plexus injury do not appear to have significant sensory impairment that impacts their bimanual hand function.


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