Recovery of biceps function after delayed repair for brachial plexus injury

Background: In many cases of severe closed injury involving the upper trunk of the brachial plexus, the proximal stump is too damaged to permit direct repair, Under these circumstances, several alternative sources of neurotization have been described, three of which are analyzed here, Methods and Results: Thirteen patients with brachial plexus injury had paralysis of elbow flexion owing to damage of either the upper trunk or the lateral cord, In four patients, the musculocutaneous nerve was reinnervated through cross-union with the thoracodorsal nerve; all regained strong elbow flexion, One of three the patients with cross-union between the lateral or medial pectoral nerve regained useful elbow flexion, Of six patients with nerve grafting between spinal accessory and musculocutaneous nerves, four regained useful elbow flexion, Conclusion: Cross-union between thoracodorsal and musculocutaneous nerves appears to be a reliable method of restoring elbow function even when delayed for 2 years after injury, Return of elbow flexion should be an obtainable goal in most brachial plexus injuries.