Nerve transfer (or neurotisation) involves the transfer of a functioning fascicle or nerve branch (expendable donor) to a denervated muscle.

Principles of motor nerve transfer (MacKinnon):

• Donor nerve near target motor end plates
• Expendable donor nerve
• Pure motor donor nerve
• Donor-recipient size match
• Donor function synergy with recipient function
• Motor re-education improves function

The choice of a donor nerve follows the same principles of tendon transfer:

  1. What (nerve) is not working?
  2. What function needs restoring? 
  3. What (donor) nerves are available (in the vicinity)?
  4. What is the most appropriate donor nerve?

Some commonly performed nerve transfers:

• Restoration of elbow flexion

o Ulnar nerve fascicle (FCU) to musculocutaneous nerve branch (biceps)
o Median nerve fascicle (FCR) to musculocutaneous nerve branch (brachialis)

• Restoration of shoulder function and stability

o Spinal accessory nerve to suprascapular nerve
o Radial nerve branch (triceps) to axillary nerve (deltoid)


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