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Upper Limb

Nerve Transfer Evidence

Restoration of elbow extension function is an integral part of UE reconstruction because recovery of this improves elbow stability, the ability to perform pressure relief maneuvers, push a manual wheelchair, reach for items and objects above shoulder height and the ability to complete functional transfers such as bed, toilet, tub and car transfers. To date there have been one case report (Brown et al. 2011) and one cadaver study (Bertelli et al. 2011) on nerve transfer for elbow extension function. The primary goal of reconstruction in hands of a person with tetraplega is the restoration of the ability to create a pinch using the thumb and lateral side of the index finger, for example when holding a key (Bertelli et al. 2012). To date there has been four published case reports (Bertelli et al. 2012Mackinnon et al. 2012Brown 2011Hsiao et al. 2009) on nerve transfer for pinch and grip. Finger extension is required for object acquisition (grasp) and object release (let go) (Kozin 2002). Two date there have been three case reports (Brown 2011Bertelli et al. 2010Palazzi et al. 2006) and one cadaver study (Bertelli et al. 2009) on nerve transfer for thumb and finger extension.

Conclusion

There are only a few reported and published studies on nerve transfer surgery for restoring hand and upper limb function after a SCI and based on the published literature, nerve transfer surgery is emerging as another surgical alternative.

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