This document discusses two Oberlin nerve transfer techniques for restoring elbow flexion after brachial plexus injury: 1. Oberlin I involves transferring a fascicle of the ulnar nerve to the motor branch of the biceps muscle. Over 100 patients who underwent this procedure regained M3 or greater elbow flexion strength, with recovery occurring between 5-11 months. 2. Oberlin II adds transferring a fascicle of the median nerve to the motor branch of the brachialis muscle. This "dual nerve transfer" technique was illustrated in a patient who showed recovery of both the biceps and brachialis muscles 10 months post-operatively. The Oberlin techniques rely on the proximity

1. Oberlin Nerve Transfer for Elbow
flexion in Brachial Plexus Injury
Somsak Leechavengvongs, M.D.
Institute of Orthopedics, Lerdsin Hospital
Bangkok Thailand

2. Oberlin Procedure
• Oberlin 1(1994)
- 1 part of ulnar nerve to biceps branch
• Oberlin 2 (2006)
- 1 part of ulnar nerve to biceps branch
- 1 part of median nerve to brachialis
branch

3. Prof. Christophe Oberlin

5. J Hand Surg 1994;19A:232-237
Prof. C. Oberlin
Bichat Hospital
Paris
Restoration of Elbow Flexion

6. Transfer of one fascicle of the
ulnar nerve to branch to Biceps

7. J Hand Surg 1998;23A:250-255
 The 1st br.
always supply the short head
 The 2nd br.
is 5-53 mm (avg, 22 mm)
distal to the 1st br.

8. J Hand Surg 1998;23A:711-716
Ulnar nerve
Nerve to biceps
an ulnar n. fascicle
the anastomosis
‘ Oberlin I ’
Biceps
Brachialis

9.  93% (30/32 Pts) obtained > or = M3
 No loss of ulnar nerve function noted
J Hand Surg 1998;23A:711-716

10.  The ulnar nerve is closer
 The rate of recovery is faster
 No nerve graft required
 Technically uncomplicated
 No special re-education required
 Reserving the other donor nerves
J Hand Surg 1998;23A:711-716

11. A part of ulnar nerve transfer to
motor branch to the biceps
• From September 1992 – February 2006
• 192 cases with 112 cases more than 2 year’s
follow – up evaluation
• 93% regained >or = M3 (C5 and C6 )
• 58% regained >or = M3 (C5,C6 and C7)
• Recovery of M3 occurred between 5 and 11
months after surgery (mean, 7 mo)

12. A part of ulnar nerve transfer to
motor branch to the biceps
• The elbow flexion power ranged from
0.5 to 7 kg (average = 2.6 kg)
• No loss of ulnar nerve was noted after surgery
• 28% experienced transient paresthesia
in the small finger

13. Ulnar nerve
Median nerve
Nerve to biceps
Nerve to brachialis
Dual Nerve Transfer
for Biceps & Brachialis
Ulnar n.
Median n.
‘Oberlin II’

14. 10 months after double nerve transfer to biceps and brachialis
using fascicle of ulnar and median nerve