Oberlin's ulnar nerve transfer to the biceps motor nerve in obstetric brachial plexus palsy: Indications, and good and bad results

We present 7 children with obstetric brachial plexus palsy treated by transferring two motor fascicles out of the ulnar nerve to the biceps nerve. Three were male, and 4 were female. The left‐side brachial plexus was affected in 4 patients, and the right side in 3 patients. All children had vaginal delivery; two of them presented with shoulder dystocia. The average birth weight was 4,300 g (range, 3,620–5,500 g). Average age at time of operation was 16 months (range, 11–24 months). The indication for the operation was absent active elbow flexion with active shoulder abduction against gravity in 4 cases, and no biceps function and bad shoulder function in 3 cases. Oberlin's ulnar nerve transfer was done in 4 cases without brachial plexus exploration in those children with good shoulder function, and exploration of the brachial plexus was performed in the other 3 cases with bad shoulder function. The average follow‐up was 19 months (range, 13–30 months). Five children had biceps muscle ≥M₃ with active elbow flexion against gravity, and 2 children had biceps muscle <M₃. We recommend Oberlin's ulnar nerve transfer for upper‐type obstetric brachial plexus palsy in 1) breech delivery with avulsion of C5 and C6 nerve roots,) late presentation with good recovery of shoulder function, and 3) neuroma‐in‐continuity of the upper trunk with intraoperative good nerve conduction for the shoulder muscles, the same as preoperative good shoulder function but with no biceps action. © 2004 Wiley‐Liss, Inc.