Provisional image — diagram of the transfer principle to come · Dr Frédéric Teboul's practice
Brachial plexus surgery applies nerve transfers to the specific case of a damaged network — it is the subject of a dedicated page. This page takes the subject at its root: what a nerve transfer is, why it changed everything, and how far this principle extends — because its reach goes well beyond the plexus alone.
The principle: move the source of command, don't repair the wire
Conventional nerve repair seeks to restore the continuity of a nerve along its entire length, from the injury to the muscle. When the injury is high or the loss of tissue substantial, this approach has a biological limit: regrowth, on the order of one millimeter per day, is so slow that the target muscle may deteriorate before the fibers reach it.
The idea that changes everything
Bring the source of command closer to the muscle. Instead of repairing the nerve from its origin, part of a nearby donor nerve that is still functioning is taken and connected to the paralyzed nerve just upstream of the muscle. The regrowth distance becomes short, reinnervation fast, and the target precise. You don't repair the wire: you move the power outlet as close as possible to the device you want to switch back on.
The two other principles of nerve transfers
Unlike a graft, only a single microsurgical suture is performed.
A nerve transfer makes it possible to tailor the match in size and in the type of electrical cable (motor, sensory, and proprioceptive fibers).
Sacrificing part of the donor nerve has little or no consequence, because it is chosen precisely because that loss is compensated for by other parts of the nerve. Within a single nerve there are several electrical cables that serve the same function, which is what makes a partial harvest possible.
Three conditions for a transfer to succeed
The success of a transfer does not rest on the procedure alone: it depends on an equation the surgeon must solve for each case.
01
A suitable donor nerve
A nerve from which all or part can be taken without creating a troublesome deficit, because its function is redundant or secondary.
02
A synergy or a proximity
A donor whose command is close — in the brain or in the movement — to the function to be restored, which makes relearning easier.
03
The right timing
A target muscle still able to respond, meaning a procedure before the deterioration becomes irreversible.
It is solving these three conditions at once — which donor, for which target, at what time — that defines expertise in this field.
A principle that applies throughout the body
The strength of the nerve transfer is that it is a general principle, not an isolated technique. Dr Teboul has helped describe several variations of it, which reflects a command of the concept itself, beyond any one location.
In the upper limb: elbow and shoulder
The most established transfers involve reanimating the upper limb: restoring elbow flexion by transferring fascicles from the ulnar nerve to the nerve to the biceps, and reanimating the shoulder — including the transfer of the rhomboid nerve to the suprascapular nerve, described by Dr Teboul's team. These techniques are detailed in the page devoted to plexus surgery.
In the lower limb: proof of a universal principle
The most telling demonstration that the transfer is a principle, and not a local recipe, is its application outside the upper limb. Dr Teboul has helped describe the transfer of two motor branches of the obturator nerve to the femoral nerve, to restore knee extension after femoral palsy — a situation whose options were long very limited.
In other fields of surgery
Nerve transfers are now used in many fields: treating limb spasticity after damage to the central nervous system, and myoelectric prostheses.
What a transfer can, and cannot, do
Being clear-eyed about the limits is part of expertise. A nerve transfer restores a useful function, not necessarily full strength or full fine control.
Where it excels
Restoring a lost key movement — bending an elbow, extending a knee, stabilizing a shoulder — when a suitable donor exists.
Where it is limited
Very fine or multiple functions, such as full control of the hand, where no single donor can replace everything.
Setting the right goals — what will be restored, to what degree, and in how much time — is an integral part of the procedure.
The time factor, again and always
Like all nerve surgery, transfers are subject to the constraint of timing: the target muscle must still be alive and able to be reinnervated — a point detailed in the page on traumatic nerve injuries. This is what makes neurotization a surgery of the right moment: a technically perfect transfer, done too late, no longer finds a muscle to reanimate. Early referral to a practitioner who has mastered these techniques is therefore decisive.
Summary at a glance
Lost function
Reference transfer
Location
Elbow flexion
Ulnar fascicles → nerve to the biceps
Upper limb
Finger extension
Transfer to the posterior interosseous nerve
Upper limb
Deltoid reinnervation
Motor branch of the triceps to the axillary nerve
Upper limb
Knee extension
Obturator branches → femoral nerve
Lower limb
These reference points show the reach of the principle: a single surgical language, from elbow to knee.
Frequently asked questions
It means reconnecting part of a still-functioning donor nerve to a paralyzed nerve, right next to the muscle to be reactivated. The brain then relearns how to control the function. You don't repair the injured nerve along its entire length: you move the source of command as close as possible to the target.
It isn't automatically better: it depends on the case. But when the injury is high, a transfer greatly shortens the distance the fibers have to travel to reach the muscle. Reinnervation is therefore faster, which matters because the muscle deteriorates over time.
Very little, because the donor is chosen precisely for having a redundant or secondary function, compensated for by other parts of the donor nerve. The loss is most often barely noticeable, which is the very condition for using that nerve as a donor.
Yes, and that is what makes it a general principle. It applies to the lower limb: for example, restoring knee extension by transferring branches of the obturator nerve to the femoral nerve, a technique Dr Teboul has helped describe. Yes, also in conditions such as spasticity, in ophthalmology, and for myoelectric prostheses.
Yes, it is essential. After a transfer, the brain has to relearn how to control one function with a nerve that used to serve another. This relearning takes place over several months, with specific rehabilitation. Brain plasticity helps enormously and naturally.
He has helped describe several transfers, beyond the plexus: the rhomboid nerve transfer for the shoulder, and the obturator-to-femoral transfer for the knee. This work is cited in the international literature.
Yes. A transfer only makes sense if the target muscle is still able to respond. After a certain time, it deteriorates and can no longer be reactivated. That is why early referral to a specialist in these techniques is decisive.
A surgeon subspecialized in the peripheral nerve and brachial plexus, skilled in the microsurgery of transfers. Dr Frédéric Teboul, a brachial plexus and peripheral nerve surgeon and member of the Académie Nationale de Chirurgie, has practiced and helped develop these techniques for 25 years.
Glossary
Nerve transfer (neurotization)
Connection of a functioning donor nerve to a paralyzed nerve, near the target muscle.
Donor nerve
A nerve that is taken, with a redundant or secondary function, to reanimate a paralyzed nerve.
Motor relearning
The process by which the brain relearns how to control the restored function after a transfer.
Obturator → femoral transfer
Transfer of obturator branches to the femoral nerve to restore knee extension.
Target muscle
The paralyzed muscle to be reactivated, which must still be able to be reinnervated for a transfer to succeed.
Scientific references
A selection of work underpinning the expertise presented here. Publications authored by Dr Teboul are shown in bold.
01
Goubier JN, Teboul F, Yeo S. Transfer of two motor branches of the anterior obturator nerve to the motor portion of the femoral nerve: an anatomical feasibility study. Microsurgery, 2012.
02
Dubois E, Popescu IA, Sturbois-Nachef N, Teboul F, Goubier JN. Repair of the femoral nerve by two motor branches of the obturator nerve: a case report. Microsurgery, 2020.
03
Goubier JN, Teboul F. New microsurgical nerve transfers in brachial plexus surgery. Annals of Physical and Rehabilitation Medicine, 2012.
04
Oberlin C, Ameur N, Teboul F, Beaulieu JY, Vacher C. Transfer of some fascicles from the ulnar nerve to the nerve to the biceps muscle. Techniques in Hand and Upper Extremity Surgery, 2002.
05
Goubier JN, Teboul F. Rhomboid nerve transfer to the suprascapular nerve for shoulder reanimation in brachial plexus palsy: a clinical report. Hand Surgery & Rehabilitation, 2016.
Page reviewed and approved by Dr Frédéric Teboul, hand, brachial plexus and peripheral nerve surgeon, member of the Académie Nationale de Chirurgie, founder of the Institute for surgery of the brachial plexus, peripheral nerves and nerve tumors (Paris).
Last updated: August 23, 2026
Page expanded, reviewed and approved by Dr Frédéric Teboul
Disclaimer. This page is intended to provide information about a specialized practice. It is not a substitute for a consultation. A paralysis warrants early specialist referral, because nerve transfers depend on timing.
Author of this publication
Every piece of content is signed by its author and reviewed before publication.
A recent paralysis? Nerve transfers depend on timing — an early opinion matters.Dr Frédéric Teboul · brachial plexus and nerve surgeon · 92 bd de Courcelles, Paris 17eBook an appointmentAsk a question
Author
Dr Frédéric Teboul
Brachial plexus and peripheral nerve surgeon · Académie Nationale de Chirurgie