Restoration of elbow flexion with nerve transfer (Oberlin transfer)

April 24th, 2007

When brachial plexus injury has occurred, and nerves have been avulsed from the cervical spinal cord, reconstructive strategies center around nerve transfer surgery. These techniques are typically used in an attempt to restore shoulder and elbow flexion.

When injury is limited to the 5th and 6th cervical roots, and elbow extension and hand function are retained, an "Oberlin" transfer is an excellent option, which avoids the morbidity of having to perform intercostal nerve transfers (see article on this page). The surgery involves transfering 1-2 fascicles from the functioning ulnar nerve to the motor branch to the biceps muscle. The goal is elbow flexion that is strong enough to overcome gravity and perform light lifting. This procedure involves a direct nerve repair very close to the muscle, thus recovery may occur within 4-6 months of surgery.

Successful outcome frees the patient from having to be in a sling for support.When I evaluate your brachial plexus injury in the office, I may need to order additional studies, which, in combination with your physical exam, will allow me to share the potential treatment options with you.

Related Photos:

Oberlin procedure is well described in the literature

Vessel loop is around the motor nerve to the biceps muscle

The ulnar nerve is identified

Ulnar nerve fascicles are ready for transfer to the motor nerve to biceps

Nerve transfer is completed

Elbow flexion 7 moths postoperatively

Nerve transfer is completed

Related Videos:

Preoperative exam shows weak and incomplete elbow flexion; the flexor-pronator mass is responsible for the small amount of flexion that is present

Intraoperative ulnar fascicular stimulation ellicits wrist flexion from stimulation of that portion of the ulnar nerve that innervates the FCU muscle;these fascicles are used for transfer to the motor nerve to biceps.

Postoperative elbow flexion 7 months after Oberlin transfer. Both biceps bulk and elbow flexion continue to improve.