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Single-stage double motor nerve transfer for all finger flexion in iatrogenic C8-T1 spinal nerve injury: a case report and review of literature

  • Case Report - Peripheral Nerves
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Abstract

Restoration of hand function after C8-T1 spinal nerve injury is challenging. We report a case of a young patient who underwent single-stage transfer of extensor carpi radialis brevis (ECRB) branch of radial nerve to flexor digitorum superficialis (FDS) branch of median nerve and transfer of brachialis branch of musculocutaneous nerve to anterior interosseous nerve (AIN), aiming for restoration of all finger flexion in iatrogenic C8-T1 spinal nerve injury after the resection of a dumbbell-shaped C8 neurofibroma. At 18 months after the operation, the fingers and thumb functions were successfully restored. The operation might be useful for restoration of hand function in selected patients with C8, T1 brachial plexus injury. From the literature review, this is the first case that the technique of double motor nerve transfer and the transfer of ECRB branch to FDS branch were used to restore finger flexion in a patient with brachial plexus injury.

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Abbreviations

ECRB:

Extensor carpi radialis brevis

FDS:

Flexor digitorum superficialis

FDP:

Flexor digitorum profundus

FPL:

Flexor pollicis longus

AIN:

Anterior interosseous nerve

MRI:

Magnetic resonance image

CMAP:

Compound muscle action potential

MUAP:

Motor unit action potential

MCP:

Metacarpophalangeal joint

PIP:

Proximal interphalangeal joint

DIP:

Distal interphalangeal joint

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Acknowledgements

We would like to acknowledge Dr. Woralux Phusoongern, neurosurgeon at Chiangmai Neurological Hospital, Thailand, for her assistance in figure illustration.

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Authors and Affiliations

  1. Department of Neurosurgery, Neurological Institute of Thailand, 312, Rajavithi Road, Thung Phayathai, Ratchathewi, Bangkok, Thailand

    Ekkapot Jitpun & Teera Tangviriyapaiboon

  2. Department of Pediatric Neurology, Neurological Institute of Thailand, Bangkok, Thailand

    Apimid Rojanawatsirivej

Authors
  1. Ekkapot Jitpun
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  2. Apimid Rojanawatsirivej
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  3. Teera Tangviriyapaiboon
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Correspondence to Ekkapot Jitpun.

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Comments

This paper by Jitpun et al. introduces a double nerve transfer for finger flexion to reconstruct C8-T1 deficit following resection of a dumbbell C8 neurofibroma. They demonstrate reasonably good functional recovery using a novel strategy of combined donors (ECRB to FDS and brachialis to AIN). Dual reconstruction of finger flexion has been reported previously. Xu et al. (1) have described dual reconstruction of finger flexion using PT to AIN and brachialis to FDS.

The theme of this paper is—is two better than one? We commend the authors on their innovation. Dual reinnervation in this scenario likely does provide stronger finger flexion and grip strength than single nerve transfer.

We have enjoyed a collaborative interdisciplinary BP clinic at our institution with Departments of Neurologic Surgery and Orthopedics. Two collaborative minds work better than one!. With this in mind, while no further neurosurgical reconstruction is possible, based on the supplemental video, there are additional elective reconstructive procedures that could improve function in the intrinsic minus hand, including an anti-claw procedure, IP joint fusion of the thumb and an opponensplasty.

Robert J. Spinner, Alexander Y. Shin

Rochester, Minnesota,USA

1. Xu B, Dong X, Zhang C-G, Gu Y-D. Multiple nerve and tendon transfers: a new strategy for restoring hand function in a patient with C7-T1 brachial plexus avulsions. J Neurosurg 127:837–842, 2017.

This article is part of the Topical Collection on Peripheral Nerves

Supplementary Information

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Supplementary file1 (MP4 35618 KB) Video 1The video shows the recovery of finger flexion at the metacarpophalangeal (MCP) and proximal interphalangeal joints (PIP). The grasp function was improved when the patient’s wrist was extended, highlighting the benefit of tenodesis effect on finger flexion. Flexor pollicis longus (FPL) and index flexor digitorum profundus (FDP) strength were restored to M2. However. there was no movement of the distal interphalangeal joint (DIP) of the 3rd- 5th fingers when examined separately.

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Jitpun, E., Rojanawatsirivej, A. & Tangviriyapaiboon, T. Single-stage double motor nerve transfer for all finger flexion in iatrogenic C8-T1 spinal nerve injury: a case report and review of literature. Acta Neurochir 164, 2683–2688 (2022). https://doi.org/10.1007/s00701-022-05264-0

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  • DOI: https://doi.org/10.1007/s00701-022-05264-0

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