Elbow flexion recovery after intercostal nerve transfer in elderly patients: a clinical experience report

Category	Detail
Condition	Complete traumatic brachial plexus injury with loss of elbow flexion
Key Mechanisms	Intercostal nerve (ICN) transfer to musculocutaneous nerve (MCN) to restore biceps function
Target Population	Elderly patients aged 60 years and older with complete brachial plexus avulsion
Care Setting	Surgical reconstruction and postoperative rehabilitation in neurosurgery and private practice settings

Elderly patients represent less than 1.6% of ICN-to-MCN transfers performed over 30 years.
Early surgery (within 2 months) with direct coaptation yields better elbow flexion recovery (M4) in older adults.
Delayed reconstruction (>5 months) and use of nerve grafts correlate with poor or absent functional recovery (M0–M2).

Confirm complete brachial plexus avulsion with clinical and electrophysiological studies (ENMG).
Exclude patients with penetrating trauma, traumatic brain injury, or neurodegenerative conditions.

Perform ICN-to-MCN nerve transfer as a reconstructive option when proximal donor nerves are unavailable.
Aim for early reconstruction preferably within 2 months post-injury to enable tension-free direct neurorrhaphy.
Avoid or minimize nerve grafting to reduce axonal loss and improve functional outcomes.
Implement structured postoperative motor rehabilitation to enhance recovery.

Assess muscle bulk and motor strength regularly postoperatively.
Monitor adherence to rehabilitation protocols.
Evaluate hormonal status (e.g., testosterone levels) as a potential factor influencing recovery.

Delayed surgery reduces likelihood of meaningful elbow flexion recovery.
Use of nerve grafts may increase regeneration distance and axonal loss.
Advanced chronological age alone should not contraindicate surgery but narrows therapeutic window.

Male patients aged 60 years and older with complete traumatic brachial plexus avulsion from motorcycle accidents.

Successful outcomes depend on early intervention, preserved muscle quality, direct nerve coaptation, and strong rehabilitation adherence.

Select elderly patients carefully considering timing and feasibility of tension-free nerve coaptation.
Prioritize early surgical reconstruction to maximize functional recovery potential.
Maintain rigorous postoperative rehabilitation to support motor reinnervation.
Consider patient-specific factors such as muscle bulk and hormonal status in prognostication.

Clinical Scorecard: Recovery of Elbow Flexion Following Intercostal Nerve Transfer in Older Adults: A Clinical Experience Overview