Distal nerve transfers for radial nerve reinnervation and hand function restoration

Radial nerve palsy, with wrist drop and loss of finger and thumb extension, severely impairs grasp and release. In proximal or extensive defects, direct repair or grafting may fail, making distal nerve transfer a preferred alternative. Can distal median-to-radial nerve transfers restore hand extension and improve quality of life in patients with radial nerve injury? This prospective study included nine patients with radial nerve injuries treated using distal nerve transfer. Surgical reconstruction consisted of transfer of the median nerve branch to the flexor digitorum superficialis to the radial nerve branch for the extensor carpi radialis brevis, combined with transfer of the median nerve branch to the flexor carpi radialis to the posterior interosseous nerve. In addition, a pronator teres to extensor carpi radialis brevis tendon transfer was performed to facilitate wrist extension in long-standing lesions. Functional recovery of wrist, finger (II–V), and thumb extension was assessed 24 months postoperatively using a modified British Medical Research Council scale, and quality of life was evaluated preoperatively and at final follow-up using the PNSQoL questionnaire. All patients achieved satisfactory recovery (BMRC M3–M5) of wrist, finger, and thumb extension, with M4–M5 outcomes predominating, especially for wrist extension. Median PNSQoL improved from 49 to 78, with 88.9% reporting excellent quality of life. Distal median-to-radial nerve transfer reliably restores hand extension and improves patient-reported outcomes in proximal radial nerve injuries, though larger multicenter studies are needed for confirmation. • Distal nerve transfer is effective for proximal radial nerve injuries • Median-to-radial transfers restore wrist, finger, and thumb extension • All patients achieved satisfactory motor recovery at 24 months • Patient-reported quality of life improved significantly after surgery