Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. Examining patients with multiple nerve injuries and neuropathic pain can be difficult due to the number of nerves that have overlapping sensory territories. As well, it is important to distinguish pain from nerve compression […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is one of our principle lectures that discusses strategies for managing nerve injuries with gaps. These strategies include nerve repair, grafting, allografts, conduits, acellularized allografts, and nerve transfers. An understanding of these […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. In this presentation, we discuss nerve transfers and reconstructive strategies for managing ulnar nerve injuries. The anterior interosseous to ulnar motor nerve transfer is the procedure, where we utilize end-to-end repair for complete nerve […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation details reconstructive options for median nerve injuries, specifically nerve transfers to reinnervate the pronator teres and anterior interosseous nerve. These two recipient nerves are critical for median nerve function and strategies for […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation details reconstructive options for radial nerve injuries, specifically median to radial nerve transfers. Indications and discussion surrounding the advantages and disadvantages for nerve transfers versus tendon transfers are presented, however the goals […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is an introduction to nerve transfers and details the indications for performing these procedures. Experimental studies are discussed in respect to nerve injury and recovery and the window for reinnervation. The classification […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is a comprehensive review of our strategies for restoring function to the shoulder and elbow through nerve transfers. In particular, these transfers are discussed in reference to brachial plexus injuries with an […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation describes our approach to management of brachial plexus injuries. This includes a description of the nerve injury classification and the appropriate electrodiagnostic tools used for assessing these challenging cases. Additionally, case examples […]
Injury to the axillary nerve results in the loss of shoulder function, specifically deltoid and teres minor deficits. This injury can either be isolated or more commonly associated with an upper brachial plexus injury that includes the C5,6 roots. The medial triceps is an available donor for nerve transfer into the axillary nerve and is […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation describes the premise for the supercharge end-to-side nerve transfer and its clinical utility for incomplete injuries involving the ulnar nerve. Specifically, this presentation discuss the indications for this procedures, the research involved […]
Loss of flexor pollicis longus and radial profundus function results in a deficit of pinch and reduced grip strength in the hand. This palsy can be isolated or commonly included in a lower brachial plexus injury. The brachialis nerve is an available, synergistic, and powerful donor for transfer in these scenarios, especially in C7,8,T1 injuries […]
Radial nerve palsy is a debilitating nerve injury that results in lost of wrist and finger extension, which classically presents as wrist drop. The two reconstructive options for managing this injury are tendon transfers and nerve transfers, each with their advantages and disadvantages. Nerve transfers are able to provide independent finger extension, however there is […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is a description on the median to radial nerve transfers for management of radial nerve palsies. It was presented at the 2014 ASSH Post-Course on distal nerve transfers for brachial plexus injuries. […]
Reconstructing shoulder function following a nerve injury is a challenge due to its dynamic movement originating from several muscles. The supra/infraspinatus muscles are critical for shoulder function in that they initiate abduction of the arm, external rotation, and stabilization of the shoulder joint. In upper brachial plexus injuries, it is common to find a deficit […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is part of the 2014 Comprehensive Review of Neurosurgery video lectures and the second part of the Acute Nerve Injury and Repair lecture. Specifically, this presentation discusses nerve transfers for the hand. […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is part of the 2014 Comprehensive Review of Neurosurgery video lectures and the first part of the Acute Nerve Injury and Repair lecture. Specifically, this presentation discusses reconstructive options for nerve injury, […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is part of the 2014 Comprehensive Review of Neurosurgery video lectures and the second part of the Brachial Plexus Lesion lecture. Specifically, this presentation discusses nerve transfers for the shoulder and elbow. […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is part of the 2014 Comprehensive Review of Neurosurgery video lectures and the first part of the Brachial Plexus Lesion lecture. Specifically, this presentation discusses the topic of treatment for brachial plexus […]
Injury to the ulnar nerve results in clawing of the hand due to lost of ulnar intrinsic hand muscles, lost of ulnar-innervated wrist/finger flexion, and numbness/pain within the ulnar nerve territory of the hand. To prevent clawing and reconstruct the ulnar intrinsic hand muscles, the anterior interosseous to ulnar motor nerve transfer is an available […]
Sensory nerve transfers are an available option for restoring sensation to critical deinnervated territories. Multiple strategies exist for restoring sensation, which include end-to-end nerve transfers for critical territories and end-to-side nerve transfers for non-critical territories. For sensory deficits in the ulnar nerve, the 3rd webspace fascicle from the median nerve can be utilized as a […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation was given for the 2012 Comprehensive Review of Neurosurgery video lectures. Specifically, this presentation discusses the topic of treatment for brachial plexus injuries, which includes presentation of common injury patterns, management algorithms […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is the second part of the topic on Acute Nerve Injury and Repair given for the 2012 Comprehensive Review of Neurosurgery video lectures. Specifically, this presentation discusses reconstructive strategies for general topics […]
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication. This presentation is the first part of the topic on Acute Nerve Injury and Repair given for the 2012 Comprehensive Review of Neurosurgery video lectures. Specifically, this presentation discusses reconstructive strategies for general topics […]
The supercharge nerve transfer is a procedure that coapts the distal end of a donor nerve to the side of the recipient nerve. Nerve regeneration is facilitated from donor to recipient through a perineurial window to enhance regeneration from the proximal regenerating nerve. This procedure can be used in cases of 2nd/3rd degree nerve injuries […]
Tendon transfers are an available option for reconstructing wrist and finger/thumb extension following radial nerve injury when nerve transfers are contra-indicated. The donor median-innervated tendons are used to reconstruct the recipient radial-innervated tendons. This tutorial describes the following tendon transfers: (1) pronator teres (PT) to extensor carpi radialis brevis (ECRB), (2) flexor carpi radialis (FCR) […]
The median to radial nerve transfer is an available option for restoring radial nerve hand function following nerve injury. This nerve transfer specifically involves the transferring of two sets of nerves. That is, the flexor carpi radialis (FCR) to posterior interosseous nerve (PIN) and the flexor digitorum superficialis (FDS) to extensor carpi radialis brevis (ECRB) […]
The pectoral fascicle of the middle trunk is an available donor nerve to transfer to restore spinal accessory nerve function. This procedure involves identifying the brachial plexus and the accessory nerve through a supraclavicular exposure. The pectoral fascicle is identified on the anterior aspect of the middle trunk deep to the identified upper trunk. Typically, […]
For distal sensory ulnar nerve injuries in the hand, there is an alternative approach in restoration of critical ulnar nerve sensation. In this case, the patient had a gunshot wound and required amputation of the small finger. As result, the ulnar aspect of the ring finger became the critical target for sensory reinnervation. In addition, […]
The medial triceps branch to axillary nerve transfer is an available option for reconstructing patients with shoulder deficits that include an axillary nerve injury. Not presented in this tutorial, the accessory to suprascapular nerve transfer is additionally performed to stabilize the humerus during its range-of-motion in these patients. The triceps to axillary nerve transfer specifically […]
For isolated anterior interosseous nerve palsies, the nerve to the flexor digitorum superficialis (FDS) is an available donor to innervate the anterior interosseous nerve (AIN) for transfer. The FDS and AIN branch are found branching from the median nerve within the same upper-middle forearm region. The nerve to the FDS branches from the median nerve […]
Patients with long thoracic nerve injuries exhibit scapular winging and sever shoulder deficits that include the inability to forward flex the shoulder past 90 degrees of range of motion. Thoracodorsal to long thoracic nerve transfer utilizes a distal posterior branch of the thoracodorsal nerve to reinnervate the distal half of the long thoracic nerve. This […]
The double fascicular transfer (DFT) includes two nerve transfers: (1) median fascicle to biceps branch and (2) ulnar fascicle to brachialis branch. The median fascicle contains nerve fibers that innervate flexor digitorum superficialis / flexor carpi radialis. The ulnar fascicle contains nerve fibers that innervate flexor carpi ulnaris. The donor fascicles can be used for […]
The donor anterior interosseous nerve (AIN) is transferred to the side of the recipient ulnar motor fascicular group within the distal forearm to preserve ulnar nerve motor intrinsics. Guyon’s canal release is a required part and is completed prior to this procedure. Specific to this case, a revision ulnar nerve transposition was completed proximally. This […]