Outcome of Oberlin II versus Intercostal Nerve to Musculocutaneous Nerve Transfer Procedure for Elbow Flexion in Adult Brachial Plexus Injury

Abstract

Introduction: In the management of brachial plexus injury restoration of elbow flexion has been prioritised over shoulder abduction in pan plexus injury due to scarcity of suitable donor nerve for nerve transfer procedure. Literature has shown promising result in restoring elbow flexion both in upper type as well as pan plexus injury by early intervention. Aim: To assess the outcomes of Oberlin II and intercostal nerve to musculocutaneous nerve transfer procedures to restore elbow flexion, in upper type and pan plexus type adult brachial plexus injury respectively. Materials and Methods: A prospective cohort study was conducted from November 2015 to October 2018 at tertiary care hospital at Cuttack, Odisha, India. Oberlin II procedure in 20 cases of upper type and intercostal nerve to musculocutaneous nerve transfer procedure in 20 cases of pan plexus type adult brachial plexus injury to restore elbow flexion, were included. In both the groups elbow flexion was assessed by British Medical Research Council (MRC) motor grading scale. Statistical analysis was made using IBM Statistical Package for the Social Sciences (SPSS) version 21.0, Pearson’s Chi-square test was used for the data analysis and p-value <0.05 was considered as significant. Results: The study had a total of 40 cases with age range from 19 to 58 years with mean age of 31.78±11.07 years. Full range of elbow flexion against gravity i.e., M3 power was achieved in 17 out of 19 (89.5%) of cases in less than six months of denervation, seven out of eight (87.5%) of cases in six to nine months of denervation and five out of 13 (38.5%) of cases in more than nine to 12 months of denervation (p-value<0.006). In case of Oberlin II procedure full range of elbow flexion against gravity i.e., M3 power or more was achieved in 100% of cases, whereas in case of intercostal nerve transfer full range of elbow flexion against gravity i.e., M3 power only was achieved in 45% of cases and M0 power in 55% of cases (p-value<0.001). Conclusion: The study has concluded that in adult brachial plexus injury early intervention by Oberlin II nerve transfer procedures results in full range of elbow flexion against gravity i.e., M3 power or more was achieved in 100% of cases. In cases of pan plexus type injury full range of elbow flexion against gravity i.e., M3 power only was achieved in 45% of cases.

Keywords

• abduction
• brachial plexus neuropathies
• hand
• nerve transfer