Nerve Transfer To Restore Pinch And Grasp For Patients With Tetraplegia

Research Objectives

To evaluate the efficacy of supinator to anterior interosseous (AIN) transfers for pinch and grasp reconstruction in patients with tetraplegia. Popularization of nerve transfers has increased reconstructive options available to patients with tetraplegia. Outcomes of supinator to posterior interosseous nerve transfers in this patient population have been documented, as well as a variety of other options for restoration of AIN function. However, outcomes of supinator to AIN transfers reconstruction have not been published.

Design

A retrospective review of all patients who received supinator to AIN transfers at our institution with at least one year follow-up was performed.

Setting

This study was performed at a tertiary referral center.

Participants

Ten patients were identified, and four were excluded for inadequate follow-up time. Data for the remaining six patients (seven limbs) was reviewed.

Interventions

Not applicable.

Main Outcome Measures

Charts were reviewed for pre- and post-operative physical exam findings, intraoperative response to nerve stimulation, and complications. The physical exams included Medical Research Council (MRC) manual muscle testing of relevant muscle groups. An MRC grade of 3 or higher was considered a successful outcome.

Results

Of the six patients (seven limbs), six had successful outcomes with MRC grade 3-4 flexor digitorum profundus and/or flexor pollicis longus function. One patient had weaker return of pinch compared to grasp. One patient reported decreased sensation to light touch at the tip of the thumb after surgery. No other donor site deficits or complications were noted.

Conclusions

Six of seven limbs in this cohort regained AIN function. However, one patient did not have any recovery 12 months after surgery. That patient's AIN was within the zone of injury (i.e. lower motor neuron injury), corroborated by the lack of response to stimulation intraoperatively; however, time to surgery was within an appropriate window. These findings suggest that supinator to AIN transfer is a viable option for restoration of pinch and grasp function in patients with spinal cord injury.

Author(s) Disclosures

None.