Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature.

We report the results of 15 patients who underwent nerve transfer for restoration of shoulder and elbow function at our institution for traumatic brachial plexus palsy. We present these results in the context of a meta-analysis of the English literature, designed to quantitatively assess the efficacy of individual nerve transfers for restoration of elbow and shoulder function in a large number of patients. One thousand eighty-eight nerve transfers from 27 studies met the inclusion criteria of the analysis. Seventy-two percent of direct intercostal to musculocutaneous transfers (without interposition nerve grafts) achieved biceps strength > or =M3 versus 47% using interposition grafts. Direct intercostal transfers to the musculocutaneous nerve had a better ability to achieve > or =M4 elbow strength than transfers from the spinal accessory nerve (41% vs 29%). The suprascapular nerve fared significantly better than the axillary nerve in obtaining > or =M3 shoulder abduction (92% vs 69%). At our institution 90% of intercostal to musculocutaneous transfers (n = 10) achieved > or =M3 bicep strength and 70% achieved > or =M4 strength. Four of seven patients achieved > or =M3 shoulder abduction with a single nerve transfer and 6 of 7 regained > or =M3 strength with a dual nerve transfer. This study suggests that interposition nerve grafts should be avoided when possible when performing nerve transfers. Better results for restoration of elbow flexion have been attained with intercostal to musculocutaneous transfers than with spinal accessory nerve transfers and spinal accessory to suprascapular transfers appear to have the best outcomes for return of shoulder abduction. We conclude that nerve transfer is an effective means to restore elbow and shoulder function in brachial plexus paralysis.