Arm adduction reinnervation utilizing contralateral C7 root in brachial plexus injuries: An anatomical study and case illustration.
- 1Division of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.
- 2Department of Neurosurgery, McMaster University, Ontario, Canada.
- 3Department of Neurosurgery, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, United States.
Abstract
Background
Brachial plexus injuries (BPI) cause severe upper limb motor and sensory deficits, with functional and psychosocial consequences. In complete BPI, restoration of the thoraco-brachial pinch through arm adduction has rarely been addressed. This study aimed to evaluate the anatomical relationship between the lateral pectoral nerve (LPN) and the contralateral C7 (CC7) root and to assess pectoralis major reinnervation outcomes.Methods
Ten brachial plexuses and 10 LPNs were dissected in five cadavers at the Anatomy Program of McMaster University. The brachial plexus and C7 root were exposed through a supraclavicular approach, and the LPN through an infraclavicular approach. After bilateral identification, a sural nerve graft was tunneled in the presternal subcutaneous plane to measure the distance between them. One patient with total BPI underwent partial CC7 transfer to the LPN using an interposed sural nerve graft.Results
All C7 roots and LPNs were identified in every specimen. The mean distance between the LPN and the CC7 root was 17.5 cm (range, 16.0-19.4). Mean diameters were 4.4 mm (3.9-5.2) for the C7 root and 1.9 mm (1.7-2.2) for the LPN. In the clinical case, the reinnervated pectoralis major achieved a British Medical Research Council grade of 4/5, with no donor-site morbidity.Conclusion
This study demonstrates an accessible, reproducible method for identifying the LPN and supports the anatomical feasibility of CC7 transfer for its reinnervation, providing anatomical and clinical data relevant to reconstructive strategies in complex BPI.
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BibTeX
@article{bourguet2026adduction,
title = {{Arm adduction reinnervation utilizing contralateral C7 root in brachial plexus injuries: An anatomical study and case illustration.}},
author = {Martin E Bourguet and Jessy Moore and Kesava Reddy and Justin M Brown and Mariano Socolovsky},
journal = {Surgical neurology international},
year = {2026},
month = oct,
doi = {10.25259/sni_953_2026},
url = {https://europepmc.org/article/MED/42974575},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Arm adduction reinnervation utilizing contralateral C7 root in brachial plexus injuries: An anatomical study and case illustration.
AU - Martin E Bourguet
AU - Jessy Moore
AU - Kesava Reddy
AU - Justin M Brown
AU - Mariano Socolovsky
PY - 2026
DA - 2026/10/23
JO - Surgical neurology international
DO - 10.25259/sni_953_2026
UR - https://europepmc.org/article/MED/42974575
AB - Background Brachial plexus injuries (BPI) cause severe upper limb motor and sensory deficits, with functional and psychosocial consequences. In complete BPI, restoration of the thoraco-brachial pinch through arm adduction has rarely been addressed. This study aimed to evaluate the anatomical relationship between the lateral pectoral nerve (LPN) and the contralateral C7 (CC7) root and to assess pectoralis major reinnervation outcomes.Methods Ten brachial plexuses and 10 LPNs were dissected in five cadavers at the Anatomy Program of McMaster University. The brachial plexus and C7 root were exposed through a supraclavicular approach, and the LPN through an infraclavicular approach. After bilateral identification, a sural nerve graft was tunneled in the presternal subcutaneous plane to measure the distance between them. One patient with total BPI underwent partial CC7 transfer to the LPN using an interposed sural nerve graft.Results All C7 roots and LPNs were identified in every specimen. The mean distance between the LPN and the CC7 root was 17.5 cm (range, 16.0-19.4). Mean diameters were 4.4 mm (3.9-5.2) for the C7 root and 1.9 mm (1.7-2.2) for the LPN. In the clinical case, the reinnervated pectoralis major achieved a British Medical Research Council grade of 4/5, with no donor-site morbidity.Conclusion This study demonstrates an accessible, reproducible method for identifying the LPN and supports the anatomical feasibility of CC7 transfer for its reinnervation, providing anatomical and clinical data relevant to reconstructive strategies in complex BPI.
SN - 2229-5097
SN - 2152-7806
ER -