Objective evaluation of elbow flexion strength and fatigability after nerve transfer in adult traumatic upper brachial plexus injuries.

Nerve transfers Oberlin-type are currently used in upper brachial plexus lesions to recover elbow flexion. Is the regained active motion sufficient to resume heavy manual activities? Five adult patients (mean age 37 years) operated of a nerve transfer to recover elbow flexion (transfer of a motor fascicle of the ulnar nerve to the motor branch of the biceps; in three patients, additional transfer from the median to the motor nerve of the brachialis) were clinically and isokinetically evaluated, after a mean follow-up of 47 months. The median Constant-Murley score was 22/100, the DASH 56/100 and the MEPI 60/100. For isokinetic tests the most significant finding was a severe deficit of elbow strength, of about 80%. No patient was able to maintain an isometric contraction during sufficient time to evaluate fatigability. This preliminary study suggests that major functional impairments persist despite early recovery of elbow flexion. These results should be confirmed in a study on a larger group of patients.