Reconstruction of elbow flexion after C5,C6 brachial plexus avulsion injuries

Objective:To investigate methods of reconstructing elbow flexion after the C5,C6 nerve avulsion in brachial plexus injuries.Methods:Seven patients were confirmed as complete C5,C6 nerve avulsion by electromyogram(EMG),magnatic resonance imaging(MRI)or physical examination before operation or by surgical exploration.Further nerve transposition was then applied to reconstruct the elbow flexion,in which motor fascicle from the ulnar nerve was transferred to the biceps branch of the musculocutaneous nerve(Oberlin transfer),partial branch of the median nerve to the brachialis branch.During this procedure,electrophysiological technique was used to improve accuracy and feasibility.Postoperative comprehensive measures,such as physical therapy,active functional training and nerve-nutrition drugs etc.were carried out.Results:Follow up ranged from 6-28 months(14 months on average)showed all patients obtained satisfied elbow flexion.The muscle power recovery in 5 cases with a follow-up period exceeding 1 year achieved as M3,2 cases with follow-up less than 8 months also achieved recovery of M1-2.Conclusions:With better recovery of muscle power,double nerve transfer is an effective method for the reconstruction of elbow flexion in patients that are confirmed as C5,C6 root never avulsion in brachial plexus injuries.