29 papers · updated 2026-09-26 · Hand & Upper Extremity · All topics
The newest papers on brachial plexus injury and nerve transfers from the orthopaedic journals The Reduction reads, newest first, each with a one-line summary. The list is drawn from the digest’s archive and refreshed every week.
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A global meta-analysis of 71.5 million births found brachial plexus birth injury incidence averages 1.4/1000 but varies widely by country, suggesting unexplored population-level risk factors beyond known clinical predictors.
Mapping Nerve Transfer Adoption in Brachial Plexus Birth Injury Reconstruction, 2005-2024.
Analysis of a national pediatric database shows nerve transfers are increasingly replacing autografting for brachial plexus birth injury, especially in older infants and among orthopaedic surgeons, with regional variation.
Revisiting the Original Narakas Classification of Brachial Plexus Birth Injuries.
This paper clarifies the original 1987 Narakas brachial plexus birth injury classification, correcting common misquotations that have distorted recovery expectations and prognosis for each group.
Does Age Predict Outcomes of Triceps to Axillary Nerve Transfer?
In 53 patients undergoing radial-to-axillary nerve transfer, meaningful M4-M5 recovery occurred across all age groups, with only a nonsignificant trend toward worse outcomes in older patients.
The Role of Amputation and Myoelectric Prosthetic Fitting in Traumatic Adult Brachial Plexus Injury.
Reviews elective amputation with myoelectric prosthetic fitting as an emerging option for adults with complete brachial plexus injury who fail nerve reconstruction, noting good function and satisfaction despite persistent neuropathic pain.
In brachial plexus decompression for thoracic outlet syndrome, a bioresorbable hydrogel wrap was safe and trended toward lower rates of persistent pain and reoperation versus no wrap, though underpowered to show significance.
Nerve Transfers to Rebalance the Spastic Wrist: An Anatomical Feasibility Study.
Cadaveric study shows FCU-to-ECRB nerve transfer is anatomically feasible in 90% of specimens, offering a potential surgical option to correct spastic wrist flexion deformities.
In a retrospective cohort, 10 minutes of intraoperative electrical stimulation during end-to-end nerve transfers was associated with significantly higher odds of achieving good (M4-M5) motor recovery.
Concordance and Discordance of Intraoperative Nerve Root Findings in Brachial Plexus Birth Injury.
In 162 BPBI patients, preoperative root-level classification agreed with intraoperative findings 83% of the time, but C7-C8 injuries were frequently underestimated, arguing for careful C8 assessment and reinterpreting Horner syndrome as a severity marker rather than a sign of global injury.
In 16 patients with isolated axillary nerve injury, using partial radial-to-axillary nerve transfer as the first-line surgical treatment produced significant gains in shoulder strength and motion without donor-site morbidity, even when performed late.
This narrative review proposes that developmental anatomical anomalies of the neonatal brachial plexus create a 'neurologic vulnerability' predisposing certain infants to Erb's palsy during delivery, suggesting decompression may complement nerve grafting.
Nonbrachial Plexopathy Diagnoses Seen in a Brachial Plexus Injury Specialty Clinic.
Seven percent of brachial plexus referrals had nonplexus diagnoses; multidisciplinary evaluation prevented misdiagnosis and guided appropriate treatment including surgery in 15% of cases.
SETS AIN-to-ulnar motor nerve transfer achieved intrinsic recovery (MRC≥3) in 81% of patients, with best results in traumatic injuries and early surgery, supporting its use for high ulnar nerve lesions.
Tendon versus nerve transfers - balancing hand function in upper extremity high nerve injuries.
Expert review compares tendon transfers, nerve transfers, and hybrid combinations for restoring function after high upper extremity nerve injuries, weighing timing and patient selection.
This narrative review argues that successful nerve transfer outcomes depend heavily on central nervous system neuroplasticity, not just peripheral reconstruction, and outlines its benefits and inherent limitations for reconstructive planning.
In 81 brachial plexus injury patients followed 24 months, preoperative depression did not affect overall motor recovery but was linked to worse outcomes specifically after partial ulnar nerve transfers.
Brachial plexus birth injury: classification, natural history and shoulder external rotation.
Recent brachial plexus birth injury studies introduce a surgical-findings classification, show most regain shoulder abduction, but external rotation recovery remains poor regardless of graft versus transfer.
Surgical Options for the Restoration of Elbow Extension After Brachial Plexus Injury.
This review outlines nerve transfer, tendon transfer, and free functioning muscle transfer options for restoring elbow extension in patients with brachial plexus injury.
Benefits of Sensory Nerve Transfers and Risks of Using the Superficial Radial Nerve as a Donor.
Sensory nerve transfers are gaining use but this review warns of significant complications and limited outcome data, especially when using the superficial radial nerve as a donor.
The failed adult traumatic brachial plexus reconstruction.
Failed brachial plexus reconstruction management includes late options such as tendon transfers, joint fusions, free functioning muscle transfers, and prosthetics tailored to patient goals.
Adult traumatic brachial plexus injuries: advances and current updates.
This review updates current surgical strategies—including nerve transfers and intraoperative electrical stimulation—for restoring upper limb function after adult traumatic brachial plexus injuries.
Distal nerve transfers for peripheral nerve injuries: indications and outcomes.
This review outlines how distal nerve transfers redirect healthy expendable nerves close to target muscles/skin to speed reinnervation with minimal donor morbidity, improving outcomes in peripheral nerve, brachial plexus, and spinal cord injuries.
Brachial plexus birth injury: advances and controversies.
Review of brachial plexus birth injury covers imaging, timing of nerve exploration, nerve transfers, and physiotherapy, though evidence remains limited and uncertain.
Functional Free Muscle Transfer for Reconstruction of Traumatic Adult Brachial Plexus Injuries.
This review outlines functional free muscle transfer techniques and surgical strategies for restoring elbow flexion, shoulder stability, and hand function after traumatic adult brachial plexus injury.
Development of a core outcome set for traumatic brachial plexus injury.
International consensus established pain, voluntary movement, and daily routine as the core outcomes to measure in adult traumatic brachial plexus injury.
This review describes the century-long evolution and structure of Mayo Clinic's multidisciplinary brachial plexus clinic, illustrating how combined surgical specialty input has enhanced management of these complex injuries.
Brachial Plexus Birth Injuries: A Critical Analysis Review.
This review covers brachial plexus birth injury, noting declining US incidence, serial exam as the standard for guiding early intervention, and the need for nerve grafting/transfer expertise given limited high-quality evidence.
Evaluation of functional outcomes after brachial plexus injury.
This review discusses how to comprehensively assess outcomes after brachial plexus injury, covering sensorimotor, functional, and psychosocial domains to guide appropriate outcome measure selection.
Adult Traumatic Brachial Plexus Injuries.
Modern brachial plexus management restores elbow flexion and shoulder stability in most cases when performed within six months with nerve transfers and muscle transfers.
Ulnar nerve transfer to biceps restores elbow flexion in C5-C6 brachial plexus avulsion without significant hand function impairment.
In 7 patients with upper brachial plexus injury, transferring the nerve to the triceps' long head to the axillary nerve (plus spinal accessory-to-suprascapular transfer) restored M4 deltoid strength and ~124° abduction without triceps weakness.
An Approach to Obstetrical Brachial Plexus Injuries
Describes a clinic's standardized approach to early evaluation of obstetrical brachial plexus palsy, emphasizing the need for reproducible grading systems to guide prognosis and surgical timing.
Nerve Transfers: Indications, Techniques, and Outcomes
This review updates indications, surgical techniques, and outcomes for nerve transfers used to treat proximal, brachial plexus, and distal upper extremity nerve injuries.
The active movement scale: An evaluative tool for infants with obstetrical brachial plexus palsy
The Active Movement Scale showed good interrater reliability and low rater-dependent variability, supporting its use for evaluating infants with obstetrical brachial plexus palsy.
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