A 30-year-old man with C5-C6 brachial plexus avulsion (loss of shoulder abduction and elbow flexion) but intact C7-T1 function is planned for Steindler flexorplasty to restore elbow flexion. This procedure involves:

• A Transferring the pectoralis major tendon to the biceps tendon
• B Intercostal nerve transfer to the musculocutaneous nerve
• C Transferring the latissimus dorsi muscle to the anterior arm to substitute for biceps
• D Advancing the common flexor origin (medial epicondyle) proximally by 4-5 cm along the humerus ✓

Explanation

Steindler flexorplasty advances the common flexor-pronator origin (attached to the medial epicondyle) proximally by 4-5 cm along the distal humerus, increasing the flexor moment arm to restore elbow flexion. It relies on intact C7-C8 innervation (pronator teres, flexor carpi radialis). Option A describes a tendon transfer for irreparable biceps. Option C describes a free functional muscle transfer. Option B describes a nerve transfer (neurotization), which is a different reconstructive strategy altogether.

Reference: Green's Operative Hand Surgery, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.