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

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)