Phrenic nerve transfer in brachial plexus injury - guidance (IPG468)

National Institute for Health and Care Excellence - NICE
Publication date:
27 November 2013


The National Institute for Health and Care Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Phrenic nerve transfer in brachial plexus injury, in November 2013.


Brachial plexus injuries are typically caused by traction of the arm at birth and by road traffic accidents. They result in loss of sensation and movement in all or part of the arm and can be associated with severe pain. The exact symptoms depend on the severity and location of the injury.

Brachial plexus injuries in which the nerves are injured but still intact are usually managed by conservative care, including physiotherapy. If the plexus has been disrupted then surgical repair is considered. This may be possible by direct suture, or it may involve the use of nerve grafts if the nerve ends are separated. If neither of these is possible, for example in nerve root avulsion, nerve transfer (neurotisation) can be done, in which a healthy nerve to a different muscle is joined to a damaged nerve, to re-innervate the affected arm muscle. A variety of nerves may be used for this kind of procedure, including intercostal nerves, the spinal accessory nerve, the phrenic nerve and the motor branches of the cervical plexus. Sometimes, free muscle or tendon transfer is done in combination with nerve transfer to re-innervate the forearm muscles.

Coding recommendations

A73.6 Transfer and reimplantation of peripheral nerve NEC

Z08.- Brachial plexus

Y54.2 Harvest of nerve of head

Includes: Harvest of nerve of neck

Z12.8 Specified nerve NEC