To restore elbow flexion in a patient with C5–C6 brachial plexus avulsion (pre-ganglionic), the most reliable donor nerve for neurotization of the musculocutaneous nerve is:

• A Intercostal nerves (ICN) III–V
• B Contralateral C7 root transfer
• C Ipsilateral ulnar nerve fascicle transfer (Oberlin procedure) ✓
• D Phrenic nerve transfer

Explanation

The Oberlin procedure (fascicular transfer from the ulnar nerve's flexor carpi ulnaris branch to the musculocutaneous nerve's biceps branch) is the procedure of choice for restoring elbow flexion in upper trunk avulsions. It offers a short reinnervation distance, large donor fascicle, and consistently yields MRC grade 3–4 elbow flexion in 80–90% of patients. ICN transfers (A) are used when both C5–C6 and possibly C7 are avulsed. Phrenic nerve (D) carries respiratory compromise risk and is reserved for total plexus palsy where other donors are unavailable.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.