Merrell (2001) — Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature

Results of Nerve Transfer Techniques for Restoration of Shoulder and Elbow Function in the Context of a Meta-Analysis of the English LiteratureCitation only

Merrell, Wolfe·J Hand Surg Am·2001·405 citations·Hand & Upper

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Key Findings

Direct intercostal-to-musculocutaneous transfers (no interposition graft) achieved ≥M3 biceps strength in 72% of cases, compared to 47% when interposition nerve grafts were used.
Direct intercostal transfers outperformed spinal accessory nerve transfers for achieving ≥M4 elbow strength (41% vs 29%).
Suprascapular nerve transfers achieved ≥M3 shoulder abduction significantly more often than axillary nerve transfers (92% vs 69%).
In the institutional series, 90% of intercostal-to-musculocutaneous transfers (n=10) reached ≥M3 biceps strength, and 70% reached ≥M4.
For shoulder abduction, 4 of 7 patients achieved ≥M3 strength with a single nerve transfer, while 6 of 7 achieved ≥M3 strength when a dual nerve transfer was performed.

Clinical Relevance

• The pooled data support avoiding interposition nerve grafts when a direct transfer is feasible, since direct coaptation nearly doubled the rate of useful biceps recovery in the meta-analysis. • The comparative donor nerve data give trainees a quantitative basis for choosing intercostal nerves over spinal accessory for elbow flexion, and spinal accessory-to-suprascapular transfers over axillary nerve grafting for shoulder abduction. • The dual-transfer results for shoulder abduction suggest that combining nerve transfers may improve the odds of functional recovery compared to a single transfer alone.

Core

Results of Nerve Transfer Techniques for Restoration of Shoulder and Elbow Function in the Context of a Meta-Analysis of the English LiteratureCitation only

Results of Nerve Transfer Techniques for Restoration of Shoulder and Elbow Function in the Context of a Meta-Analysis of the English Literature|Citation only

Key Findings

Clinical Relevance

Results of Nerve Transfer Techniques for Restoration of Shoulder and Elbow Function in the Context of a Meta-Analysis of the English Literature|Citation only

Key Findings

Clinical Relevance

Results of Nerve Transfer Techniques for Restoration of Shoulder and Elbow Function in the Context of a Meta-Analysis of the English Literature|Citation only

Key Findings

Clinical Relevance

Results of Nerve Transfer Techniques for Restoration of Shoulder and Elbow Function in the Context of a Meta-Analysis of the English Literature|Citation only

Key Findings

Clinical Relevance

Results of Nerve Transfer Techniques for Restoration of Shoulder and Elbow Function in the Context of a Meta-Analysis of the English LiteratureCitation only

Results of Nerve Transfer Techniques for Restoration of Shoulder and Elbow Function in the Context of a Meta-Analysis of the English LiteratureCitation only

Results of Nerve Transfer Techniques for Restoration of Shoulder and Elbow Function in the Context of a Meta-Analysis of the English LiteratureCitation only

Results of Nerve Transfer Techniques for Restoration of Shoulder and Elbow Function in the Context of a Meta-Analysis of the English LiteratureCitation only