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Selective Neurotization of the Median Nerve in the Arm to Treat Brachial Plexus Palsy

An Anatomic Study and Case Report

¹ Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi zhong Road, Shanghai, 200040, China. E-mail address for X. Zhao: zhaoxin888{at}sina.com.cn
² Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong

Investigation performed at the Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China, and the Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Methods: Internal topographic features of the fascicular groups of the median nerve were observed in seventeen cadavera. On the basis of the anatomical results, selective neurotization of the posterior fascicular group of the median nerve in the arm was performed in one patient with a complete brachial plexus palsy.

Results: In the distal half of the arm, the branches of the median nerve consistently collect into three fascicular groups, which are located at the anterior, middle, and posterior parts of the median nerve trunk. The anterior fascicular group is composed of the branches to the pronator teres and the flexor carpi radialis, the posterior fascicular group is composed mainly of the anterior interosseous nerve and the branches to the palmaris longus, and the middle fascicular group is made up mostly of the branches to the hand and the flexor digitorum superficialis. A transfer of the full length of the phrenic nerve was used to selectively reinnervate the posterior fascicular group of the median nerve in a patient with a complete brachial plexus palsy. The muscles supplied by the posterior fascicular group regained Grade-4 power, according to the system of the Medical Research Council, sixteen months after surgery.

Conclusions and Clinical Relevance: The typical arrangement of the fascicular groups of the median nerve in the arm favors the technique of selective neurotization, which has been used effectively in one patient to date.

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