Nerve Transfers for Treatment of Upper Extremity Paralysis in Acute Flaccid Myelitis

Abstract

Acute flaccid myelitis (AFM) is a rare, debilitating neurological disease resulting in pure motor deficits in school-aged children. Unfortunately, 90% of patients do not experience complete spontaneous recovery, and medical therapy has not proven efficacious. Herein, we report the course of 2 patients with AFM who underwent upper extremity nerve transfers to treat persistent upper extremity paralysis after failing roughly 6.5 months of conservative treatment. Objective comparisons were made between preoperative and postoperative examinations using the Active Movement Scale and Mallet Classification. Patient 1 underwent transfers of spinal accessory to suprascapular nerve, medial pectoral to axillary nerve, flexor carpi radialis motor fascicle to motor fascicles of the biceps and brachialis musculocutaneous nerve, and anterior interosseous transfer to deep motor branch of the ulnar nerve. Patient 2 underwent transfers of the left spinal accessory to suprascapular nerve and motor nerve of the long head of the triceps to axillary nerve. Both patients experienced significant improvement in muscle strength and ability to complete activities of daily living, with near complete recovery of function. Nerve transfers in the upper extremity within 1 year of symptom onset appear to be beneficial for children with persistent weakness.