Rethinking Recovery: Beyond the 18-month Milestone in Nerve Transfer Surgery.

PURPOSE: Conventional dogma is that recovery following nerve transfer surgery plateaus ∼18 months post operation. This widely accepted notion has shaped patient counselling, patient expectations, and clinical follow-up protocols. This study aims to re-examine the long-term recovery beyond 18 months and present novel findings that challenge the conventional recovery timeline.

MATERIALS AND

METHODS

A retrospective review of adult patients who underwent nerve transfer surgery more than 5 years ago was conducted. Once identified, these patients were contacted to perform a telephone survey, a qualitative interview, and a clinical re-examination of the reinnervated muscles. Patient-reported outcomes were gathered using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and objective muscle strength was evaluated using the British Medical Research Council (BMRC) scale.

RESULTS

Thirty-one patients were identified for having undergone 37 nerve transfers longer than 5 years ago. The documented 18-month postoperation BMRC grade, 5 years ago, was an average of 3.3/5. Clinical re-examinations of 22 of these patients, a minimum of 5 years post nerve transfer, showed significant improvements in muscle strength, with the average BMRC grade to 4.4/5. Most patients (90.3%) experience continued functional recovery beyond 18 months. The average DASH score, more than 5 years following their nerve transfer, was 24.7, indicating an overall positive functional outcome. Notably, 87.1% of patients resumed work or preinjury activities.

CONCLUSION

This study suggests that nerve recovery extends beyond the traditionally accepted 18-month timeframe, thereby highlighting the need to amend patient counselling and expectations and revise the follow-up and rehabilitation protocols to optimize long-term success following nerve transfer surgery.