Intraoperative FCU CMAP Amplitude During Oberlin Nerve Transfer: Association with Reinnervation Timing and Functional Outcomes

Background/Objectives: Selective transfer of an ulnar nerve fascicle to the motor branch of the musculocutaneous nerve (Oberlin technique) is widely used to restore elbow flexion following upper brachial plexus injury. Intraoperative neurophysiological mapping allows quantitative recording of compou...

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Autores: Ortega Hernández, Diana Marcela, Fernández-Conejero, Isabel, Casado Rodríguez, Aroa, Tarnawski Español, Guillermo José, Miró, Júlia, Casañas Sintes, Joaquin, Llusá Pérez, Manuel
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2026
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:dnet:ubarcelona__::91a0aeff83e12351f7d805ea12cd250b
Acceso en línea:https://hdl.handle.net/2445/229709
Access Level:acceso abierto
Palabra clave:Regeneració del sistema nerviós
Plexe braquial
Nervi cubital
Nervis espinals
Nervous system regeneration
Brachial plexus
Ulnar nerve
Spinal nerves
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spelling Intraoperative FCU CMAP Amplitude During Oberlin Nerve Transfer: Association with Reinnervation Timing and Functional OutcomesOrtega Hernández, Diana MarcelaFernández-Conejero, IsabelCasado Rodríguez, AroaTarnawski Español, Guillermo JoséMiró, JúliaCasañas Sintes, JoaquinLlusá Pérez, ManuelRegeneració del sistema nerviósPlexe braquialNervi cubitalNervis espinalsNervous system regenerationBrachial plexusUlnar nerveSpinal nervesBackground/Objectives: Selective transfer of an ulnar nerve fascicle to the motor branch of the musculocutaneous nerve (Oberlin technique) is widely used to restore elbow flexion following upper brachial plexus injury. Intraoperative neurophysiological mapping allows quantitative recording of compound muscle action potentials (CMAPs) during donor fascicle selection; however, its prognostic relevance remains unclear. This study evaluated whether intraoperative flexor carpi ulnaris (FCU) CMAP amplitude is associated with time to electromyographic reinnervation of the biceps brachii and with final functional outcomes. Methods: A retrospective observational study was conducted including patients who underwent selective nerve transfer to the biceps brachii between 2006 and 2025 at two tertiary referral centers. Donor fascicles were selected using intraoperative neurophysiological mapping with quantitative CMAP recordings from three ulnar-innervated muscles. Primary outcomes were time to electromyographic evidence of reinnervation and final elbow flexion strength assessed using the British Medical Research Council grading system. Associations were analyzed using nonparametric statistical methods. Results: Twenty patients met the inclusion criteria. Higher intraoperative FCU CMAP amplitudes were associated with a shorter time to electromyographic reinnervation (Spearman ρ = −0.572, p = 0.0106). No association was observed between CMAP amplitude and final elbow flexion strength (Spearman ρ = −0.168, p = 0.479), or between time to reinnervation and final functional outcome (Spearman ρ = −0.276, p = 0.253). A positive association was found between the injury-to-surgery interval and intraoperative CMAP amplitude (Spearman ρ = 0.681, p = 0.000943). Conclusions: The intraoperative FCU CMAP amplitude facilitates objective donor fascicle selection and is associated with earlier electromyographic reinnervation. Nevertheless, it was not associated with final elbow flexion strength in this cohort and should be interpreted as a technical adjunct rather than a standalone prognostic indicator. Functional recovery following nerve transfer appears to reflect multifactorial biological and temporal determinants beyond a single intraoperative neurophysiological measurement. These findings should be interpreted cautiously given the limited sample size.MDPI2026info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/229709reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.3390/jcm15072476Journal of Clinical Medicine, 2026, vol. 15, num. 7, 2476https://doi.org/10.3390/jcm15072476cc-by (c) Ortega-Hernández, D.M. et al., 2026http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:dnet:ubarcelona__::91a0aeff83e12351f7d805ea12cd250b2026-05-27T06:46:51Z
dc.title.none.fl_str_mv Intraoperative FCU CMAP Amplitude During Oberlin Nerve Transfer: Association with Reinnervation Timing and Functional Outcomes
title Intraoperative FCU CMAP Amplitude During Oberlin Nerve Transfer: Association with Reinnervation Timing and Functional Outcomes
spellingShingle Intraoperative FCU CMAP Amplitude During Oberlin Nerve Transfer: Association with Reinnervation Timing and Functional Outcomes
Ortega Hernández, Diana Marcela
Regeneració del sistema nerviós
Plexe braquial
Nervi cubital
Nervis espinals
Nervous system regeneration
Brachial plexus
Ulnar nerve
Spinal nerves
title_short Intraoperative FCU CMAP Amplitude During Oberlin Nerve Transfer: Association with Reinnervation Timing and Functional Outcomes
title_full Intraoperative FCU CMAP Amplitude During Oberlin Nerve Transfer: Association with Reinnervation Timing and Functional Outcomes
title_fullStr Intraoperative FCU CMAP Amplitude During Oberlin Nerve Transfer: Association with Reinnervation Timing and Functional Outcomes
title_full_unstemmed Intraoperative FCU CMAP Amplitude During Oberlin Nerve Transfer: Association with Reinnervation Timing and Functional Outcomes
title_sort Intraoperative FCU CMAP Amplitude During Oberlin Nerve Transfer: Association with Reinnervation Timing and Functional Outcomes
dc.creator.none.fl_str_mv Ortega Hernández, Diana Marcela
Fernández-Conejero, Isabel
Casado Rodríguez, Aroa
Tarnawski Español, Guillermo José
Miró, Júlia
Casañas Sintes, Joaquin
Llusá Pérez, Manuel
author Ortega Hernández, Diana Marcela
author_facet Ortega Hernández, Diana Marcela
Fernández-Conejero, Isabel
Casado Rodríguez, Aroa
Tarnawski Español, Guillermo José
Miró, Júlia
Casañas Sintes, Joaquin
Llusá Pérez, Manuel
author_role author
author2 Fernández-Conejero, Isabel
Casado Rodríguez, Aroa
Tarnawski Español, Guillermo José
Miró, Júlia
Casañas Sintes, Joaquin
Llusá Pérez, Manuel
author2_role author
author
author
author
author
author
dc.subject.none.fl_str_mv Regeneració del sistema nerviós
Plexe braquial
Nervi cubital
Nervis espinals
Nervous system regeneration
Brachial plexus
Ulnar nerve
Spinal nerves
topic Regeneració del sistema nerviós
Plexe braquial
Nervi cubital
Nervis espinals
Nervous system regeneration
Brachial plexus
Ulnar nerve
Spinal nerves
description Background/Objectives: Selective transfer of an ulnar nerve fascicle to the motor branch of the musculocutaneous nerve (Oberlin technique) is widely used to restore elbow flexion following upper brachial plexus injury. Intraoperative neurophysiological mapping allows quantitative recording of compound muscle action potentials (CMAPs) during donor fascicle selection; however, its prognostic relevance remains unclear. This study evaluated whether intraoperative flexor carpi ulnaris (FCU) CMAP amplitude is associated with time to electromyographic reinnervation of the biceps brachii and with final functional outcomes. Methods: A retrospective observational study was conducted including patients who underwent selective nerve transfer to the biceps brachii between 2006 and 2025 at two tertiary referral centers. Donor fascicles were selected using intraoperative neurophysiological mapping with quantitative CMAP recordings from three ulnar-innervated muscles. Primary outcomes were time to electromyographic evidence of reinnervation and final elbow flexion strength assessed using the British Medical Research Council grading system. Associations were analyzed using nonparametric statistical methods. Results: Twenty patients met the inclusion criteria. Higher intraoperative FCU CMAP amplitudes were associated with a shorter time to electromyographic reinnervation (Spearman ρ = −0.572, p = 0.0106). No association was observed between CMAP amplitude and final elbow flexion strength (Spearman ρ = −0.168, p = 0.479), or between time to reinnervation and final functional outcome (Spearman ρ = −0.276, p = 0.253). A positive association was found between the injury-to-surgery interval and intraoperative CMAP amplitude (Spearman ρ = 0.681, p = 0.000943). Conclusions: The intraoperative FCU CMAP amplitude facilitates objective donor fascicle selection and is associated with earlier electromyographic reinnervation. Nevertheless, it was not associated with final elbow flexion strength in this cohort and should be interpreted as a technical adjunct rather than a standalone prognostic indicator. Functional recovery following nerve transfer appears to reflect multifactorial biological and temporal determinants beyond a single intraoperative neurophysiological measurement. These findings should be interpreted cautiously given the limited sample size.
publishDate 2026
dc.date.none.fl_str_mv 2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/229709
url https://hdl.handle.net/2445/229709
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.3390/jcm15072476
Journal of Clinical Medicine, 2026, vol. 15, num. 7, 2476
https://doi.org/10.3390/jcm15072476
dc.rights.none.fl_str_mv cc-by (c) Ortega-Hernández, D.M. et al., 2026
http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by (c) Ortega-Hernández, D.M. et al., 2026
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv MDPI
publisher.none.fl_str_mv MDPI
dc.source.none.fl_str_mv reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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