In total brachial plexus avulsion (C5–T1), which nerve is most commonly used as an extraplexal donor for neurotisation to restore elbow flexion?

• A Ipsilateral phrenic nerve
• B Contralateral C7 nerve root
• C Spinal accessory nerve (XI) ✓
• D Intercostal nerves (T3–T5)

Explanation

The spinal accessory nerve (cranial nerve XI) is the most widely used extraplexal donor for neurotisation to the musculocutaneous nerve, restoring elbow flexion. It provides approximately 1200–1400 myelinated axons, and its harvest causes only mild shoulder weakness (trapezius denervation) with good functional compensation. Intercostal nerves are also used, particularly for hand function. The contralateral C7 requires an interpositional graft and is better for wrist/finger extension restoration.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.