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Outcome following phrenic nerve transfer to musculocutaneous nerve in patients with traumatic brachial palsy: a qualitative systematic review

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The phrenic nerve can be transferred to the musculocutaneous nerve in patients with traumatic brachial plexus palsy in order to recover biceps strength, but the results are controversial. There is also a concern about pulmonary function after phrenic nerve transection. In this paper, we performed a qualitative systematic review, evaluating outcomes after this procedure.


A systematic review of published studies was undertaken in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Data were extracted from the selected papers and related to: publication, study design, outcome (biceps strength in accordance with BMRC and pulmonary function) and population. Study quality was assessed using the “strengthening the reporting of observational studies in epidemiology” (STROBE) standard or the CONSORT checklist, depending on the study design.


Seven studies were selected for this systematic review after applying inclusion and exclusion criteria. One hundred twenty-four patients completed follow-up, and most of them were graded M3 or M4 (70.1 %) for biceps strength at the final evaluation. Pulmonary function was analyzed in five studies. It was not possible to perform a statistical comparison between studies because the authors used different parameters for evaluation. Most of the patients exhibited a decrease in pulmonary function tests immediately after surgery, with recovery in the following months. Study quality was determined using STROBE in six articles, and the global score varied from 8 to 21.


Phrenic nerve transfer to the musculocutaneous nerve can recover biceps strength ≥M3 (BMRC) in most patients with traumatic brachial plexus injury. Early postoperative findings revealed that the development of pulmonary symptoms is rare, but it cannot be concluded that the procedure is safe because there is no study evaluating pulmonary function in old age.

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Correspondence to Marcio de Mendonça Cardoso.

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This paper reviews the literature on using the phrenic nerve to neurotize the musculocutaneous nerve or its distal motor branches to restore elbow flexion, particularly in clinical settings of nerve root avulsion where other nerve repair options are very limited. It is comprehensive, thoughtful, and points out a major shortcoming which is that no one has studied the long-term effects of having only one phrenic nerve to support ventilation, particularly in older patients. Hopefully this shortcoming will be addressed by future studies.

Michel Kliot

Illinois, USA

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de Mendonça Cardoso, M., Gepp, R. & Correa, J.F.G. Outcome following phrenic nerve transfer to musculocutaneous nerve in patients with traumatic brachial palsy: a qualitative systematic review. Acta Neurochir 158, 1793–1800 (2016).

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