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Surgeons at the Center for Nerve Injury and Paralysis perform a procedure called a double fascicular nerve transfer in patients who have an upper brachial plexus injury or isolated nerve injury resulting in an inability to flex the arm.


Nerve transfer to restore elbow flexion. (From Weber RV, Mackinnon SE. Nerve Transfers in the Upper Extremity. Journal of the American Society for Surgery of the Hand. 2004:4(3):2004. Reprinted with permission from Elsevier.)

Nerve transfers involve taking nerves with less important roles — or branches of a nerve that perform redundant functions to other nerves — and “transferring” them to restore function in a more crucial nerve that has been severely damaged.

Elbow flexing requires movement of two muscles — the biceps muscle and the brachialis muscle. In a double fascicular nerve transfer, the surgeon uses portions of two separate nerves that are normally not connected to the biceps and brachialis muscles to restore elbow flexion. During the procedure, a segment of the ulnar nerve, which allows wrist flexion, and a segment of the median nerve, which provides finger or wrist flexion, are cut and transferred directly to the biceps and brachialis branches of the musculocutaneous nerve.

Patients will still be able to flex their fingers and wrist after surgery. However, as they regain function from the nerve transfer, they also will be trained to use muscles in the fingers and wrists to trigger movement in the upper arm that allows them to flex their elbow. The brain then learns this trick, and eventually you are able to activate the biceps simply by thinking about moving the biceps.

Recovery of function after any nerve reconstruction can be a long process. Some patients have seen small signs of recovery as early as two months after the operation, but in most cases, return of function begins somewhere around six months, with full recovery in about two years.