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Tendon Transfers for Radial Nerve Palsy in Brachial Plexus Injuries
Ali Izadpanah, MD; Allen Bishop, MD; Robert Spinner, MD; Michelle, F. Kircher, RN; Alexander Y. Shin, MD
Mayo Clinic, Rochester, MN

Introduction: Every year more than 1 million people suffer from peripheral nerve injuries. In this study, we sought to determine the outcome of tendon transfers in our patient population with brachial plexus injury undergoing radial nerve palsy tendon transfers and to further compare the results with patients undergoing similar transfer for non-brachial plexus type injuries.

Methods: A retrospective chart review analysis of patients undergoing tendon transfers to address radial nerve deficits treated at our institution from September 2001 to October 2014 with minimum of six months follow up was performed. DASH scores were recorded in patients with brachial plexus injuries and compared with the postoperative values. A paired t-test analysis was performed between the preoperative DASH scores and postoperative values.

Results: A total of 71 patients underwent tendon transfers for radial nerve palsy. Forty two patients (59.2%) were due to brachial plexus injuries and 29 patients (40.8%) were secondary to isolated radial nerve palsies. Twenty seven patients had the traditional Starr transfers. Out of these 27 patients, 15 (55.6%) had palsy secondary to plexus injuries and the remaining 12 (44.4%) had palsies secondary to isolated radial nerve palsies. There were no complications in perioperative period. The DASH score for patients with brachial plexus injury improved from 51.524.09 to 27.9810.95 (p=0.0026). All patients in group 1 achieved full finger extension, wrist extension of 42.58.4 from -26.56.8, and a postoperative wrist flexion of 20.96.9. Patients in group 2 all achieved full finger extension other than two patients. The average postoperative wrist extension in this group was 42.56.89 and 5011.18 of wrist flexion. All patients other than the two with suboptimal outcomes had British Medical Research Council System (BMRC) score of 5. The two patients in group 2 with weak extension had preoperative BMRC scores of 4. Not considering the two patients with BMRC scores of less than 5, there was no difference between the two groups in postoperative wrist extension (p=0.80), finger extension (p=0.90). However the wrist flexion at final follow up was significantly better in group 2 (5011.18) compared to group 1 (20.96.9) (p>0.05).

Conclusion: Starr transfer is an effective method in patients with both isolated radial nerve and combined radial nerve palsies in brachial plexus patients. Both groups of patients achieved similar improvements provided they had similar muscle strength preoperatively. Only a subgroup of patients with BMRC of less than 5 had less than optimal range of motion after these transfers.

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