{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T23:43:58Z","timestamp":1775778238559,"version":"3.50.1"},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":98,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Brachial Plex Peripher Nerve Inj"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Restoration of elbow extension in obstetric brachial plexus injury (OBPI) with triceps paralysis is essential for optimizing upper limb function, although often considered a secondary objective.<\/jats:p>\n                  <jats:p>To assess long-term functional outcomes of triceps reinnervation via nerve transfers in pediatric OBPI patients with persistent triceps paralysis.<\/jats:p>\n                  <jats:p>This retrospective cohort included 16 patients who underwent triceps reanimation between 2007 and 2018. Inclusion criteria were the absence of active elbow extension and a minimum 4-year follow-up. Depending on the lesion level, nerve transfers involved motor branches of the ulnar nerve to the flexor carpi ulnaris (FCUm) and intercostal nerves. Descriptive notes of these procedures are provided in the text. Outcomes were evaluated using the Medical Research Council (MRC) scale for strength and Gilbert's Elbow Scale (GES) for function.<\/jats:p>\n                  <jats:p>Mean age at surgery was 48.9 months (range: 8\u201396), with a minimum follow-up of 4 years. At final evaluation, triceps strength improved significantly (mean MRC: 3.75, median: 4) as did elbow function (mean: GES 3.75, median: 4) compared with preoperative values (p\u2009&lt;\u20090.01). Triceps recovery contributed to a mean 35-degree reduction in elbow flexion contracture, suggesting a preventive role against progressive deformity. No complications or donor site morbidity were observed.<\/jats:p>\n                  <jats:p>Delayed nerve transfers for triceps reinnervation\u2014performed up to 8 years of age\u2014yielded satisfactory long-term results without compromising recovery. These findings support including elbow extension restoration among surgical priorities in OBPI management, even for complete brachial plexus palsies when suitable donor nerves remain available after primary reconstructions.<\/jats:p>","DOI":"10.1055\/a-2837-4190","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T22:50:21Z","timestamp":1775775021000},"page":"e1-e6","source":"Crossref","is-referenced-by-count":0,"title":["Nerve Transfer for Triceps Reinnervation in Obstetrical Brachial Plexus Injury: Long-Term Functional Results"],"prefix":"10.1055","volume":"21","author":[{"given":"Filippo M.","family":"S\u00e9n\u00e8s","sequence":"additional","affiliation":[{"name":"Senior Medical Consultant of Hand Surgery Department, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Susini","sequence":"additional","affiliation":[{"name":"Hand Surgery Department, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Grazia","family":"Calevo","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Institute Giannina Gaslini, Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Arrigoni","sequence":"additional","affiliation":[{"name":"Hand Surgery and Microsurgery Unit of IRCCS Istituto Giannina Gaslini, Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nunzio","family":"Catena","sequence":"additional","affiliation":[{"name":"Hand Surgery and Microsurgery Unit of IRCCS Istituto Giannina Gaslini, Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"issue":"11","key":"ref1","doi-asserted-by":"crossref","first-page":"2229","DOI":"10.1016\/j.jhsa.2015.08.014","article-title":"Transfer of a terminal motor branch nerve to the flexor carpi ulnaris for triceps muscle reinnervation: anatomical study and clinical cases","volume":"40","author":"J Bertelli","year":"2015","journal-title":"J Hand Surg Am"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1177\/1753193408101466","article-title":"Lower trapezius muscle transfer for reconstruction of elbow extension in brachial plexus injuries","volume":"34","author":"J A Bertelli","year":"2009","journal-title":"J Hand Surg Eur Vol"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1097\/BTH.0b013e318196c92d","article-title":"Posterior deltoid-to-triceps tendon transfer to restore active elbow extension in patients with tetraplegia","volume":"13","author":"C W Bonds","year":"2009","journal-title":"Tech Hand Up Extrem Surg"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1055\/s-0033-1357280","article-title":"Delayed selective neurotization for restoration of elbow and hand functions in late presenting obstetrical brachial plexus palsy","volume":"30","author":"T A El-Gammal","year":"2014","journal-title":"J Reconstr Microsurg"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"E516","DOI":"10.1227\/NEU.0b013e31822ac120","article-title":"Transfer of a motor fascicle from the ulnar nerve to the branch of the radial nerve destined to the long head of the triceps for restoration of elbow extension in brachial plexus surgery: technical case report","volume":"70","author":"L P Flores","year":"2012","journal-title":"Neurosurgery"},{"issue":"01","key":"ref6","first-page":"70","article-title":"R\u00e9paration chirurgicale du plexus brachial dans la paralysie obst\u00e9tricale","volume":"110","author":"A Gilbert","year":"1984","journal-title":"Chirurgie"},{"issue":"S 05","key":"ref7","doi-asserted-by":"crossref","first-page":"S68","DOI":"10.1016\/j.injury.2019.10.052","article-title":"Partial ulnar nerve transfer to the branch of the long head of the triceps to recover elbow extension in C5, C6 and C7 brachial plexus palsy","volume":"50","author":"J N Goubier","year":"2019","journal-title":"Injury"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1002\/micr.20822","article-title":"Reanimation of elbow extension with intercostal nerves transfers in total brachial plexus palsies","volume":"31","author":"J N Goubier","year":"2011","journal-title":"Microsurgery"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1097\/bth.0b013e31803105e1","article-title":"Transfer of the intercostal nerves to the nerve of the long head of the triceps to recover elbow extension in brachial plexus palsy","volume":"11","author":"J N Goubier","year":"2007","journal-title":"Tech Hand Up Extrem Surg"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1016\/j.jhsa.2009.11.026","article-title":"Current concepts in the management of brachial plexus birth palsy","volume":"35","author":"H B Hale","year":"2010","journal-title":"J Hand Surg Am"},{"issue":"06","key":"ref11","doi-asserted-by":"crossref","first-page":"558.e1","DOI":"10.1016\/j.jhsa.2019.07.016","article-title":"Lower trapezius muscle transfer for elbow extension reconstruction after failed nerve transfer for tetraplegia","volume":"45","author":"S Nehete","year":"2020","journal-title":"J Hand Surg Am"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/0363-5023(94)90011-6","article-title":"Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases","volume":"19","author":"C Oberlin","year":"1994","journal-title":"J Hand Surg Am"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"e2","DOI":"10.1055\/s-0035-1549367","article-title":"Nerve transfer in delayed obstetrical palsy repair","volume":"10","author":"F S\u00e9n\u00e8s","year":"2015","journal-title":"J Brachial Plex Peripher Nerve Inj"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"221","DOI":"10.47102\/annals-acadmedsg.V45N5p221","article-title":"Nerve transfer for elbow extension in obstetrical brachial plexus palsy","volume":"45","author":"F M Senes","year":"2016","journal-title":"Ann Acad Med Singap"},{"issue":"02","key":"ref15","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1097\/BPO.0b013e3181cf2e82","article-title":"Restoration of elbow extension after primary reconstruction in obstetric brachial plexus palsy","volume":"30","author":"J K Terzis","year":"2010","journal-title":"J Pediatr Orthop"},{"issue":"95","key":"ref16","doi-asserted-by":"crossref","first-page":"e313","DOI":"10.15557\/JoU.2023.0037","article-title":"Role of high-resolution ultrasound and magnetic resonance neurography in the evaluation of peripheral nerves in the upper extremity","volume":"23","author":"A Serhal","year":"2023","journal-title":"J Ultrason"}],"container-title":["Journal of Brachial Plexus and Peripheral Nerve 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