Long Term Outcomes of Nerve Transfers in Adult Patients with C5–C7 and C5–C8 Brachial Plexus Injuries

Background. Nerve reconstructions for C5 to C8 brachial plexus injuries are challenging due to the extent of injury and paucity of nerve donors. Objective. The objective of this paper was to determine the long-term clinical outcomes of nerve transfers for shoulder and elbow function in patients with C5–C7 or C5–C8 brachial plexus injuries. Methodology. We retrospectively reviewed the charts of all patients with C5–C7 or C5–C8 brachial plexus injuries treated with nerve transfers from January 1, 2005, to December 31, 2022, with at least 24 months follow-up. Filipino Version of the Disability of the Arm, Shoulder and Hand (FIL-DASH) scores, range of motion (ROM), and muscle strength were compared between single and double nerve transfers, and between early (within six months of injury) and delayed (more than six months) surgery. Results. A total of 21 patients with a mean age of 29.9 years old were included. The mean surgical delay was 6.4 ± 3.0 months, while the mean follow-up was 58.5 ± 29.7 months. There were 11 patients with C5–C7 injuries, and 10 patients with C5–C8 injuries. FIL-DASH scores were available for eight patients, with a mean postoperative improvement of 25 points. There were no significant differences between single (SNT) and double nerve transfers (DNT) in terms of elbow flexion and shoulder function. Early surgery (within six months of injury) resulted in higher mean shoulder abduction range (110º vs 51º) compared to delayed surgery (more than six months). Conclusion. Good elbow flexion and shoulder abduction recovery can be expected in nerve transfers for patients with C5–C7 or C5–C8 brachial plexus injuries. A higher ROM for shoulder abduction can be expected if surgery is done within six months of injury.