{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:16:21Z","timestamp":1790806581783,"version":"4.1.0"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2009,5]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Medial pectoral nerve (MPN) to musculocutaneous nerve (MCN) neurotization for recovery of elbow flexion by biceps reinnervation is a valid option following traumatic injury to the upper brachial plexus. A major criticism of the application of this technique in infants is the smaller size of the MPN and mismatch of viable axons. We describe our institutional experience utilizing this procedure and critically examine functional outcomes.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Office charts and hospital records of children from over an 11-year period beginning January 1997 were reviewed. Of the 53 children of various ages undergoing brachial plexus exploration for traumatic injury of any nature, 20 underwent MPN to MCN neurotization as a part of an overall procedure in the first year of life to treat birth-related brachial plexus palsy and had at least 9 months' follow-up. Medial pectoral nerve to MCN neurotization was chosen if the results of clinical examination and intraoperative electrophysiological evidence were consistent with medial cord function. Functional recovery was defined as the ability of the child to bring their hand to their mouth.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Sixteen patients (80%) gained functional recovery. The median age at surgery was 7 months. Median time to first clinic visit documenting recovery was 11.5 months and median overall follow up was 21.5 months. Preoperative hand function was a useful predictor of recovery of elbow flexion.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Medial pectoral nerve to MCN neurotization is a valid surgical option for the reinnervation of the biceps muscle for birth-related brachial plexus palsy when the hand is functional preoperatively. Useful elbow flexion can be expected in the majority of these children.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2008.11.peds08166","type":"journal-article","created":{"date-parts":[[2009,9,22]],"date-time":"2009-09-22T12:27:37Z","timestamp":1253622457000},"page":"348-353","source":"Crossref","is-referenced-by-count":38,"title":["Medial pectoral nerve to musculocutaneous nerve neurotization for the treatment of persistent birth-related brachial plexus palsy: an 11-year institutional experience"],"prefix":"10.3171","volume":"3","author":[{"given":"John C.","family":"Wellons","sequence":"first","affiliation":[{"name":"Section of Pediatric Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Shane","family":"Tubbs","sequence":"additional","affiliation":[{"name":"Section of Pediatric Neurosurgery and"},{"name":"Department of Cell Biology, University of Alabama at Birmingham, Birmingham, Alabama; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A.","family":"Pugh","sequence":"additional","affiliation":[{"name":"Section of Pediatric Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine J.","family":"Bradley","sequence":"additional","affiliation":[{"name":"Section of Pediatric Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles R.","family":"Law","sequence":"additional","affiliation":[{"name":"Division of Rehabilitation Medicine, Children's Hospital of Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Grabb","sequence":"additional","affiliation":[{"name":"Pediatric Neurosurgery, Memorial Hospital for Children, Colorado Springs, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4 Suppl","key":"b1-0030348","series-title":"J Neurosurg","first-page":"276","article-title":"Long-term motor outcome analysis using a motor score composite following surgical brachial puexus repair","volume":"106","author":"Ashley","year":"2007"},{"key":"b2-0030348","series-title":"Morphologie","first-page":"25","article-title":"A connecting branch between the musculocutaneous nerve and the median nerve","volume":"84","author":"Basar","year":"2000"},{"key":"b3-0030348","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"365","DOI":"10.3171\/jns.2004.101.3.0365","article-title":"Surgical repair of brachial plexus injury: a multinational survey of experienced peripheral nerve surgeons","volume":"101","author":"Belzberg","year":"2004"},{"key":"b4-0030348","series-title":"Compendium of Human Anatomic Variation","author":"Bergman","year":"1988"},{"key":"b5-0030348","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1227\/01.NEU.0000073420.66113.66","article-title":"Transfer of pectoral nerves to the musculocutaneous nerve in obstetric upper brachial plexus palsy","volume":"53","author":"Blaauw","year":"2003"},{"key":"b6-0030348","series-title":"Anat Anz","first-page":"187","article-title":"[Variations of the median nerve and musculocutaneous nerve and their connections.]","volume":"102","author":"Buch-Hansen","year":"1995"},{"key":"b7-0030348","series-title":"Clin Anat","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1002\/ca.1085","article-title":"Patterns of connections between the musculocutaneous and median nerves in the axilla and arm","volume":"15","author":"Choi","year":"2002"},{"key":"b8-0030348","series-title":"Am J Orthop","first-page":"777","article-title":"Anatomic variations of the musculocutaneous nerve in the arm","volume":"26","author":"Eglseder","year":"1997"},{"key":"b9-0030348","series-title":"Folia Morphol (Warsz)","first-page":"217","article-title":"A study on the morphology of the coracobrachialis muscle and its relationship with the musculocutaneous nerve","volume":"60","author":"el-Naggar","year":"2001"},{"key":"b10-0030348","series-title":"Verhandlungen des Naturhistorisch-medizinischer Vereins Heidelberg","first-page":"130","article-title":"Ueber eine eigenthumliche Localisation von Lahmungen im Plexus brachialis","volume":"1","author":"Erb","year":"1874"},{"key":"b11-0030348","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"59","DOI":"10.3171\/jns.1990.72.1.0059","article-title":"Nerve transposition for the restoration of elbow flexion following brachial plexus avulsion injuries","volume":"72","author":"Friedman","year":"1990"},{"key":"b12-0030348","series-title":"Chirurgie","first-page":"70","article-title":"[Surgical repair of the brachial plexus in obstetric paralysis.]","volume":"110","author":"Gilbert","year":"1984"},{"key":"b13-0030348","series-title":"Neurosurgery","first-page":"3121","article-title":"Brachial plexus injuries","volume":"Vol III","author":"Guha","year":"1996"},{"key":"b14-0030348","series-title":"Childs Nerv Syst","first-page":"555","article-title":"Obstetric brachial plexus lesions: a survery and treatment protocol based on figures from Western Denmark","volume":"11","author":"Haase","year":"1995"},{"key":"b15-0030348","series-title":"Neurosurgery","first-page":"203","article-title":"Surgical relationship of the medial pectoral nerve to the musculocutaneous nerve: a cadaveric study","volume":"48","author":"Hansasuta","year":"2001"},{"key":"b16-0030348","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"386","DOI":"10.3171\/jns.2001.94.3.0386","article-title":"Use of intercostal nerves for neurotization of the musculocutaneous nerve in infants with birth-related brachial plexus palsy","volume":"94","author":"Kawabata","year":"2001"},{"key":"b17-0030348","series-title":"BMJ","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1136\/bmj.1.2197.298","article-title":"Suture of the brachial plexus in birth paralysis of the upper extremity","volume":"1","author":"Kennedy","year":"1903"},{"key":"b18-0030348","series-title":"Hand Clin","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.hcl.2004.09.002","article-title":"Direct plexus repair by grafts supplemented by nerve transfers","volume":"21","author":"Kline","year":"2005"},{"key":"b19-0030348","series-title":"Pediatric Neurosurgery: Surgery of the Developing Nervous System","first-page":"953","article-title":"Brachial plexus injury","author":"Laurent","year":"2001"},{"key":"b20-0030348","series-title":"Principles and Practice of Pediatric Neurosurgery","first-page":"897","article-title":"Brachial plexus trauma and other peripheral nerve injuries of childhood","author":"Laurent","year":"1999"},{"key":"b21-0030348","series-title":"J Anat","first-page":"79","article-title":"The distribution of nerves in the upper limb, with reference to variabilities and their clinical significance","volume":"55","author":"Linell","year":"1921"},{"key":"b22-0030348","series-title":"Folia Morphol (Warsz)","first-page":"356","article-title":"An unusual union of the intercostobrachial and medial pectoral nerve","volume":"66","author":"Loukas","year":"2007"},{"key":"b23-0030348","series-title":"Clin Anat","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1002\/ca.20315","article-title":"The surgical anatomy of the ansa pectoralis","volume":"19","author":"Loukas","year":"2006"},{"key":"b24-0030348","series-title":"Clin Anat","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1002\/ca.20328","article-title":"Medial and lateral pectoral nerves: course and branches","volume":"20","author":"Macchi","year":"2007"},{"key":"b25-0030348","series-title":"J Hand Surg [Am]","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1053\/jhsu.2001.21518","article-title":"Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature","volume":"26","author":"Merrell","year":"2001"},{"issue":"5","key":"b26-0030348","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Nerve transfers for severe brachial plexus injuries: a review","volume":"16","author":"Midha","year":"2004"},{"key":"b27-0030348","series-title":"Kaibogaku Zasshi","first-page":"191","article-title":"Three cases of the musculocutaneous nerve not perforating the coracobrachialis muscle","volume":"72","author":"Nakatani","year":"1997"},{"key":"b28-0030348","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1007\/s00381-005-1261-y","article-title":"Management of birth brachial plexus palsy","volume":"22","author":"O'Brien","year":"2006"},{"key":"b29-0030348","series-title":"J Hand Surg [Am]","doi-asserted-by":"publisher","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\u2013C6 avulsion of the brachial plexus: anatomical study and report of four cases","volume":"19","author":"Oberlin","year":"1994"},{"key":"b30-0030348","series-title":"East Afr Med J","first-page":"498","article-title":"Communication of the musculocutaneous nerve with the median nerve","volume":"77","author":"Prasada Rao","year":"2000"},{"key":"b31-0030348","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1097\/00005373-199705000-00007","article-title":"Recovery of biceps function after delayed repair for brachial plexus injury","volume":"42","author":"Richardson","year":"1997"},{"key":"b32-0030348","series-title":"Am J Orthop","first-page":"690","article-title":"Examination of the lateral antebrachial cutaneous nerve: an anatomic study in human cadavers","volume":"27","author":"Rosen","year":"1998"},{"key":"b33-0030348","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"191","DOI":"10.3171\/jns.1992.76.2.0191","article-title":"Nerve transfer in brachial plexus traction injuries","volume":"76","author":"Samardzic","year":"1992"},{"key":"b34-0030348","series-title":"Neurosurgery","first-page":"1277","article-title":"Transfer of the medial pectoral nerve: myth or reality?","volume":"50","author":"Samardzic","year":"2002"},{"key":"b35-0030348","series-title":"Collection of Cases and Observations in Midwifery","first-page":"446","volume":"Vol 2","author":"Smellie","year":"1768"},{"key":"b36-0030348","series-title":"J Hand Surg [Br]","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1054\/jhsb.2000.0367","article-title":"Transfer of a single fascicle from the ulnar nerve to the biceps muscle after avulsions of upper roots of the brachial plexus","volume":"25","author":"Sungpet","year":"2000"},{"key":"b37-0030348","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"1485","DOI":"10.2106\/00004623-200407000-00018","article-title":"Transfer of fascicles from the ulnar nerve to the nerve to the biceps in the treatment of upper brachial plexus palsy","volume":"86","author":"Teboul","year":"2004"},{"key":"b38-0030348","series-title":"Folia Morphol (Warsz)","first-page":"99","article-title":"A variation in the formation of the median nerve: communicating branch between the musculocutaneous and median nerves in the man","volume":"60","author":"Uzun","year":"2001"},{"key":"b39-0030348","series-title":"Neurological Classics","first-page":"114","article-title":"Erb's Palsy","author":"Wilkins","year":"1997"},{"key":"b40-0030348","series-title":"J Hand Surg [Am]","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1016\/S0363-5023(05)80289-8","article-title":"The musculocutaneous nerve and its branches to the biceps and brachialis muscles","volume":"20","author":"Yang","year":"1995"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/3\/5\/article-p348.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/3\/5\/article-p348.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/3\/5\/article-p348.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T11:53:18Z","timestamp":1681559598000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/3\/5\/article-p348.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2009,5]]},"references-count":40,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2008.11.peds08166","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,5]]}}}