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Advances in Nerve Transfer Techniques for Brachial Plexus Birth Palsy

This presentation discusses the latest concepts and techniques in nerve transfer for managing brachial plexus birth palsy (BPBP). It covers definitions, historical context, and classic transfers, as well as new strategies in neurotization. Key topics include the priority of function in nerve roots, donor nerve selection, and innovative approaches for elbow flexion and shoulder stability. Presenting different strategies for upper and whole BP injuries, this talk emphasizes tailored treatments for both adult and obstetric brachial plexus injuries.

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Advances in Nerve Transfer Techniques for Brachial Plexus Birth Palsy

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  1. In the name of Allah

  2. Nerve transfer in BPBP Reza Sh. Kamrani Ortopaedic surgeon Hand surgeon TUMS 16th Iranian Ortopaedic Surgeon Association Congress, Hand surgery symposium 9 / 8 /1387 Tehran IRAN

  3. Neurotization • Definition • History • Nerve transfer

  4. Nerve transfer in Brachial Plexus Birth Palsy • Classic transfer in brachial plexus • . • . • . • . • New concepts in nerve transfer ?

  5. Nerve transfer in Brachial Plexus Inj. • Classic transfer in brachial plexus (When?) • .When nerve root is avulsed • .When nerve graft is not possible • . • . • New concepts in nerve transfer

  6. Nerve transfer in Brachial Plexus Inj. • Classic transfer in brachial plexus (How?) • .Which function (root/trunk/branch) is in priority ? • .Which donor nerve is our choice ? • . • . • New concepts in nerve transfer

  7. Nerve transfer in Brachial Plexus Inj. • Classic transfer in upper brachial plexus • .Which function (root/trunk/branch) is in priority • .Which donor nerve is our choice • . • . • New concepts in nerve transfer Elbow flexion Lateral cord MC Shoulder abd. Sup.Scap Axill.

  8. Nerve transfer in Brachial Plexus Inj. • Classic transfer in upper brachial plexus • .Which function (root/trunk/branch) is in priority • .Which donor nerve is our choice • . • . • New concepts in nerve transfer Oberlin Mod. Oberlin Radial? Accessory Radial ICN.

  9. Median to biceps Ulna to brachialis Accessory to Sup. Scapular

  10. Accessory to Sup. Scapular

  11. Nerve transfer in Brachial Plexus Inj. • Classic transfer in whole brachial plexus • .Which function (root/trunk/branch) is in priority • .Which donor nerve is our choice • . • . • New concepts in nerve transfer Elbow flexion Shoulder stability Sensation of medial border of the hand Wrist and finger function

  12. Nerve transfer in Brachial Plexus Inj. • Classic transfer in whole brachial plexus • .Which function (root/trunk/branch) is in priority • .Which donor nerve is our choice • . • . • New concepts in nerve transfer Accessory / Pherenic Shoulder stability Sensation of medial border of the hand Wrist and finger function

  13. Nerve transfer in Brachial Plexus Inj. • Classic transfer in whole brachial plexus • .Which function (root/trunk/branch) is in priority • .Which donor nerve is our choice • . • . • New concepts in nerve transfer Accessory / Pherenic Pherenic / Accessory Sensation of medial border of the hand Wrist and finger function

  14. Nerve transfer in Brachial Plexus Inj. • Classic transfer in whole brachial plexus • .Which function (root/trunk/branch) is in priority • .Which donor nerve is our choice • . • . • New concepts in nerve transfer Accessory / Pherenic Pherenic / Accessory Contralateral C7 + vascularized ulna /ICN to Median

  15. Pherenic to Sup. Scapular Acc. +graft to MC

  16. Contralateral C7 + ulna to Median

  17. ICN

  18. Nerve transfer in Brachial Plexus Inj. • Classic transfer in brachial plexus • .When nerve root is avulsed • .When nerve graft is not possible • . • . • New concepts in nerve transfer

  19. Nerve transfer in Brachial Plexus Inj. • Classic transfer in brachial plexus • .When nerve root is avulsed • .When nerve graft is not possible • . • . • New concepts in nerve transfer

  20. Nerve transfer in Brachial Plexus Inj. • Classic transfer in brachial plexus • .When nerve root is avulsed • .When nerve graft is not possible • New concepts in nerve transfer

  21. Nerve transfer in Brachial Plexus Inj. • Classic transfer in brachial plexus • . • . • New concepts in nerve transfer • .Even in ruptured roots • .Even in more distal injuries ? • .Even in penetrating injury ??

  22. Treatment strategy in BPI • Classic • Nerve graft and plexus reconstruction whenever possible • New concept • Primary nerve transfer

  23. Treatment strategy in UBPI pannupan oberlin

  24. Treatment strategy in UBPI pannupan oberlin • Acc. to Sup. Scap • Mod. Oberlin • Rad. To Axill • Shoulder arthrodesis (manual worker) • ICN to Triceps (C5-7) • Pherenic to Sup. Scap • Oberlin

  25. Treatment strategy in WBPI pannupan oberlin • Pherenic to Sup. Scap • Acc.+graft to MC • Contralat C7+ vascularized ulna to Median • Classic plexus reconstruction

  26. Introduction • Nerve transfer in Brachial Plexus Inj. • Classic transfer in brachial plexus • . • . • . • . • New concepts in nerve transfer

  27. Nerve transfer in Brachial Plexus Birth Palsy • Classic transfer in brachial plexus • . • . • . • . • New concepts in nerve transfer ?

  28. Differences between Adult BPI and Obstetric BPI

  29. Adult BP inj. Obstetric BP inj. • Adult • Infant • Shorter regeneration distance • Stronger potential for regeneration • Greater capacity for brain adaptation

  30. Adult BP inj. Obstetric BP inj. • Goal • Goal

  31. Upper BPI Adult BP inj. Obstetric BP inj. • Goal • Elbow flexion • Shoulder stability • Goal • Elbow flexion • Shoulder reanimation

  32. Whole BPI Adult BP inj. Obstetric BP inj. • Goal • Elbow flexion • Shoulder stability • Medial border sensation • Wrist and finger function • Intrinsic function • Goal • Hand function • Elbow flexion • Shoulder reanimation

  33. Nerve transfer Adult BP inj. Obstetric BP inj. • Classic nerve transfer • .Intra plexus • Avulsion is more common • . • New concept • Classic nerve transfer • .Intra plexus • Avulsion is less common • . • New concept

  34. Nerve transfer Adult BP inj. Obstetric BP inj. • Classic nerve transfer • .Intra plexus • Avulsion is more common • .Extra plexus • Pherenic is available • Ulna can be sacrifized • New concept • Classic nerve transfer • .Intra plexus • Avulsion is less common • .Extra plexus • Pherenic is forbiden • Ulna must be reconstruct • New concept

  35. Whole Adult BP inj. Obstetric BP inj. • Classic nerve transfer • Intra plexus • .C5 to upper trunk • .C6 to middle trunk • .C5/C6 Lateral cord/ Medial cord • ICN+Pherenic adding • New concept • Classic nerve transfer • Intra plexus • .C5 to C8T1 • .C6 to • .Acc. To Sup. Scap • ICN adding • New concept

  36. Whole Adult BP inj. Obstetric BP inj. • Classic nerve transfer • Extra plexus • .Pherenic to Sup. Scap • .Acc. To MC • .Contra lateral C7 to Median • ICN adding • New concept • Classic nerve transfer • Extra plexus • .Acc. To Sup. Scap • ICN+ contralat C7 to median-ulna-radial • New concept

  37. Upper Adult BP inj. Obstetric BP inj. • Classic nerve transfer • .Acc. To Sup. Scap • .Mod Oberlin • .Rad. To Axill • New concept • Classic nerve transfer • .RARE • .Acc. to Sup. Scap • .Oberlin • New concept

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