A Prospective Randomized Comparison of Median and Ulnar Fascicle Transfers to the Biceps Motor Branch in Upper Brachial Plexus Injury.

BACKGROUND: Transfer of an ulnar nerve fascicle to the motor branch of the biceps has been widely adopted in patients with upper brachial plexus injuries, with consistently favorable outcomes. Transfer of a median nerve fascicle has also been reported to yield satisfactory results. This study aimed to compare the outcomes of median and ulnar nerve fascicle transfer to the biceps in patients with C5-C6 and C5-C7 brachial plexus injuries.

METHODS: A total of 50 consecutive patients underwent surgery between June 2013 and December 2018. The donor nerve was randomized before surgery. After excluding 12 patients due to intraoperative nerve stimulation finding (one nerve stronger than the other) and 5 patients with less than 6 months of follow-up, 33 patients were included in the final analysis. These patients were randomized into group 1 (ulnar nerve fascicle transfer, n = 18) and group 2 (median nerve fascicle transfer, n = 15).

RESULTS: Elbow flexion against gravity was achieved in 14 of 18 (78%) patients in group 1 versus 13 of 15 (87%) in group 2. There was no statistically significant difference (P = .665) between the comparing groups with respect to the ability to perform elbow flexion against gravity.

CONCLUSION: In this cohort, no statistically significant differences were observed between median and ulnar nerve fascicle transfers regarding elbow flexion recovery. The median nerve appears to be a viable alternative donor.