Transfer of nerve branch to the brachialis to reconstruct elbow extension in incomplete tetraplegia: case report.

We undertook a brachialis to triceps nerve transfer to restore elbow extension in a 53-year-old man 5 months after he sustained a spine injury that resulted in a central cord syndrome. Within 3 months of surgery, the patient had recovered active elbow extension and had M3 level strength, which increased to M4 and 5 kg of strength by 12 months postoperatively. Despite transferring an antagonist nerve for triceps reinnervation, the patient had no problems controlling active elbow flexion-extension. Harvesting the brachialis nerve caused no permanent decrease in elbow flexion strength.