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Introduction: In 1994, Oberlin et al. published their clinical experience with the transfer of ulnar nerve fascicles to the biceps for the treatment of upper brachial plexus injuries. Following studies with the Oberlin procedure also reported good results in terms of elbow flexion recovery with no noticeable donnor nerve morbidity. Currently, the Oberlin procedure is considered a standard approach to restore bíceps function in C5-C6 injuries due to Its technical simplicity, shorter reinervation period  and stronger muscle contraction. Although there is some consense that the interval between the injury and the transfer should be less than 12 months, there is no clinical evidence regarding the upper limit of time in which the procedure should be forsaken. Also, there are only few studies addressing the possibility of using median nerve fascicles instead of ulnar nerve in this type of transfer. The objective of this study is to report our outcomes of median nerve fascicle transfer to the biceps and also demonstrate that this transfer it’s feasible in long standing upper brachial plexus injuries.

Patients and Methods: From 2004 to 2009 we performed five median nerve fascicle transfer to the bíceps in five patients with upper brachial plexus injuries. In three of these patients, the elapsed time between the injury and the surgery was superior to 18 months. The mean age of these patients was 23,6 years (22 to 30) and they were all males with C5-C6 injuries. The mean ellapsed time between the injury and the surgery was 14,8 months (9 to 19 months). The mean follow-up period was 27,4 months (12 to 72 months).

Results: All patients regained usefull elbow flexion within one year of follow-up. Three patients achieved M4 and two patients achieved M3 elbow flexion strength, according to the Medical Research Council. Two of the three patients with M4 grade were operated after 19 months of injury. Only one of the five patients had transient numbness and weakness in the median nerve distribution in the early post-operative period. These symptoms were spontaneously resolved before 3 months of follow-up.

Conclusion: The modified Oberlin transfer using motor fascicles of the median nerve gave the same good results  when compared to the traditional ulnar nerve fascicle transfer. Recovery of usefull elbow flexion (> M3 ) was possible, even in patients with more than 18 months interval between the injury and the nerve transfer.