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A nerve transfer is a surgical technique that may be used when a patient has a nerve injury resulting in complete loss of muscle function or sensation.

Median to radial transfer

Distal AIN to median recurrent motor branch transfer. All illustrations from Mackinnon SE, Novak C. Nerve Transfers. Hand Clinics. Reprinted with permission of 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. The surgeon will use functioning nerves that are close to the target muscle or sensory area, and these nerves are transferred or “plugged in” to the injured nerve that no longer functions. The nerve that has been “plugged in” now supplies that function. For example, if a breathing nerve is used to restore elbow flexion, the patient may initially have to take a deep breath to move the arm. The brain then learns this trick and soon the patient is able to move the arm simply by thinking about moving the arm. Motor nerves are used to re-innervate muscles and sensory nerves are utilized to restore sensation. This technique provides a nearby source of nerve for faster recovery.

An example of an injured nerve that may be treated through this technique is the ulnar nerve. The ulnar nerve travels down the arm and controls both movement of the small muscles of the hand and sensation in a portion of the hand including the fourth and fifth fingers. A surgeon may use a motor branch of the median nerve to revive muscle function and a sensory branch of the same nerve to restore feeling in the hand.

A very successful nerve transfer is the one used to restore the ability to flex the elbow. The "double fascicular" nerve transfer uses small branches of the large ulnar and median nerves to plug into the nerve branches to the biceps and brachialis muscles very close to these muscle bellies. Strong elbow flexion is restored rapidly.

The center's surgeons select procedures, such as nerve decompressions, nerve grafts or nerve transfers based on a patient's condition and which technique offers the best chance of recovery.