Reconstruction of Prehension in C7-T1 Brachial Plexus Injury with Nerve and Tendon Transfers

Abstract

Case: Reconstruction of function in C7-T1 lower brachial plexus injury requires restoration of finger flexion and extension with nerve or tendon transfers. A 22-year-old man was involved in an all-terrain vehicle rollover accident. First-stage nerve transfers included extensor carpi radialis brevis to the anterior interosseous nerve and supinator to the posterior interosseous nerve. After second-stage (15 months later) side-to-side flexor digitorum profundus and Camitz abductorplasty, he was able to achieve tripod pinch and power grip. Conclusion: A combined approach with nerve transfers followed by tendon transfers allows restoration of prehension in lower BPI while preserving the brachialis as a backup donor.