Which nerve transfer (neurotization) is most commonly performed to restore elbow flexion in a patient with upper trunk brachial plexus avulsion (C5-C6) when both roots are avulsed?

• A Intercostal nerves (3–4 slips) transferred to the musculocutaneous nerve ✓
• B Spinal accessory nerve (cranial nerve XI) transfer to the long thoracic nerve
• C Radial nerve transfer to the axillary nerve
• D Contralateral C7 nerve transfer to the median nerve

Explanation

In C5-C6 avulsion, restoring elbow flexion (biceps/brachialis via musculocutaneous nerve) is the highest priority. Intercostal nerve transfers (3–4 intercostal nerves harvested at the anterior axillary line) to the musculocutaneous nerve are the most established technique for elbow flexion restoration; they provide useful donor axons and allow relearning with breathing movements. Spinal accessory (CN XI) transfer is typically used for shoulder abduction (suprascapular nerve) restoration. Contralateral C7 is used for whole arm or specific functional targets but involves more complex surgery. Radial-to-axillary transfer is for shoulder abduction, not elbow flexion.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.