To study the outcome of elbow flexion reconstruction of Oberlin operation (end to end neuroanastomosis of musculocunatenous nerve-bicep’s branch to ulnar nerve) in the treatment of brachial plexus upper root avulsion and its long term result.

From January, 2004 to July, 2016, 72 patients with brachial plexus upper root avulsion had received Oberlin operation (end to end neuroanastomosis of musculocunatenous nerve-bicep’s branch to ulnar nerve) , 50 males and 22 females, 35 cases on the left side and 37 on the right. An average age of 34 years (8-52 years) , time from injury to operation were 3-9 months, an average of 5.5 months, an average of follow up were 3 years 7 months. All patients were diagnosed with brachial plexus upper root avulsion by comprehensive physical examination, electromyocardiogram and cervical MRI (make sure muscle strength innervated by ulnar nerve were ≥ M₄). Among 72 patients, 55 were C₅-C₆ root avulsion and 17 were C₅-C₇ root avulsion. Elbow flexion function and Bicep muscle’s strength were measured after operation (muscle’s strength was measured by British Medical Research Council score system M₀-M₅). Muscle’s strength recovery was considered as poor if <M₃ and it was considered as good if ≥M₃.

In 72 cases, 62 were successfully followed up (86.11%). Seven patients were lost of follow up (9.72%) and 3 patients didn’t received operation due to ulnar nerve anomaly (4.17%). Six-two patients were measured bicep’s muscle strength at last follow up, among them there were 49 patients recovered muscle strength ≥M₃ (79.03%) and 13 patients recovered muscle strength <M₃ (20.97%).

Oberlin operation is an effective operation in the treatment of brachial plexus upper root avulsion, one thing noted in this operation is that biggest bicep branch of musculocutaneous nerve need to be selected and neuroanastomosis with ulnar nerve, otherwise post-operative ineffective bicep movement may occur.

Brachial plexus; Root avulsion; Ulnar nerve bundle; Nerve transfer; Musculocutanous nerve