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The motor level according to the ASIA (American Spinal Injury Association) classification was C-5 in 4 upper limbs, C-6 in 10, and C-7 in 3.<\/jats:p>\n<jats:p>In 3 upper limbs, the nerve to the brachialis was transferred to the anterior interosseous nerve (AIN), which was separated from the median nerve from the antecubital fossa to the midarm. In 5 upper limbs, the nerve to the brachialis was transferred to median nerve motor fascicles innervating finger flexion muscles in the midarm. In 4 upper limbs, the nerve to the brachioradialis was transferred to the AIN. In the remaining 5 upper limbs, the nerve to the extensor carpi radialis brevis (ECRB) was transferred to the AIN. Patients were followed for an average of 16 months (SD 6 months). At the final evaluation the range of finger flexion and strength were estimated by manual muscle testing according to the British Medical Research Council scale.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Restoration of finger flexion was observed in 4 of 8 upper limbs in which the nerve to the brachialis was used as a donor. The range of motion was incomplete in all 5 of these limbs, and the strength was M3 in 3 limbs and M4 in 1 limb. Proximal retrograde dissection of the AIN was associated with better outcomes than transfer of the nerve to the brachialis to median nerve motor fascicles in the arm. After the nerve to the brachioradialis was transferred to the AIN, incomplete finger flexion with M4 strength was restored in 1 limb; the remaining 3 limbs did not show any recovery. Full finger flexion with M4 strength was demonstrated in all 5 upper limbs in which the nerve to the ECRB was transferred to the AIN. No functional downgrading of elbow flexion or wrist extension strength was observed.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>In patients with tetraplegia, finger flexion can be restored by nerve transfer. Nerve transfer using the nerve to the ECRB as the donor nerve produced better recovery of finger flexion in comparison with nerve transfer using the nerve to the brachialis or brachioradialis.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2016.5.spine151544","type":"journal-article","created":{"date-parts":[[2016,8,5]],"date-time":"2016-08-05T14:11:33Z","timestamp":1470406293000},"page":"55-61","source":"Crossref","is-referenced-by-count":104,"title":["Nerve transfers for restoration of finger flexion in patients with tetraplegia"],"prefix":"10.3171","volume":"26","author":[{"given":"Jayme A.","family":"Bertelli","sequence":"first","affiliation":[{"name":"Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubar\u00e3o; and"},{"name":"Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florian\u00f3polis, Santa Catarina, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos F.","family":"Ghizoni","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florian\u00f3polis, Santa Catarina, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-spine151544","series-title":"J Neurotrauma","doi-asserted-by":"publisher","first-page":"1371","DOI":"10.1089\/neu.2004.21.1371","article-title":"Targeting recovery: priorities of the spinal cord-injured population","volume":"21","author":"Anderson KD:","year":"2004","unstructured":"Anderson KD: Targeting recovery: priorities of the spinal cord-injured population. 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