This 1994 landmark paper by Oberlin et al. describes the anatomical basis and early clinical results of what became known as the Oberlin transfer. The technique harvests one fascicle (~10%) of the ulnar nerve and coapts it directly to the biceps motor branch, eliminating the need for nerve grafting. Four patients with C5-C6 root avulsion are reported, supported by cadaveric morphometry in 20 arms.
The two options available before this technique were both flawed: intercostal nerve transfer yielded weak and uncertain elbow flexion, and spinal accessory nerve transfer to the musculocutaneous nerve — while achieving MRC grade 3 in 75% of the authors' own series. Permanently sacrificed any chance of shoulder reconstruction.
The Oberlin transfer is now first-line for elbow flexion after C5-C6 avulsion. Harvest one fascicle from the ulnar nerve in the upper arm at the ~12 cm from acromion landmark, coapt it directly to the biceps motor branch, and simultaneously transfer the spinal accessory nerve to the suprascapular nerve for shoulder abduction recovery.
Tell your patient to expect the first biceps contraction around 10–12 weeks. Reassure them that grip and pinch are preserved, as the harvested fascicle represents only ~10% of the ulnar nerve's bulk.
This paper directly enabled the double fascicular transfer (Leechavengvongs, adding a median nerve fascicle to the brachialis), which represents the current evolution of this technique and further improved outcomes.
This 1994 landmark paper by Oberlin et al. describes the anatomical basis and early clinical results of what became known as the Oberlin transfer. The technique harvests one fascicle (~10%) of the ulnar nerve and coapts it directly to the biceps motor branch, eliminating the need for nerve grafting. Four patients with C5-C6 root avulsion are reported, supported by cadaveric morphometry in 20 arms.
The two options available before this technique were both flawed: intercostal nerve transfer yielded weak and uncertain elbow flexion, and spinal accessory nerve transfer to the musculocutaneous nerve — while achieving MRC grade 3 in 75% of the authors' own series. Permanently sacrificed any chance of shoulder reconstruction.
The Oberlin transfer is now first-line for elbow flexion after C5-C6 avulsion. Harvest one fascicle from the ulnar nerve in the upper arm at the ~12 cm from acromion landmark, coapt it directly to the biceps motor branch, and simultaneously transfer the spinal accessory nerve to the suprascapular nerve for shoulder abduction recovery.
Tell your patient to expect the first biceps contraction around 10–12 weeks. Reassure them that grip and pinch are preserved, as the harvested fascicle represents only ~10% of the ulnar nerve's bulk.
This paper directly enabled the double fascicular transfer (Leechavengvongs, adding a median nerve fascicle to the brachialis), which represents the current evolution of this technique and further improved outcomes.