Brachial plexus injuries are among the most complex and disabling conditions in neurology and surgery. In the most severe cases, when all the main branches are damaged – a condition known as total brachial plexus injury – the function of the shoulder, arm, and hand can be completely lost.
Today, however, scientific research is opening promising horizons thanks to the combination of nerve surgery and advanced cellular biotechnologies.
A recent clinical study, published in 2024 in the European Journal of Orthopaedic Surgery & Traumatology, evaluated for the first time the effectiveness of local implantation of umbilical cord-derived mesenchymal stem cells (UC-MSCs) or their secretome, in combination with intercostal nerve transfer to the median nerve. This procedure is typically performed in late brachial plexus injuries (more than 6 months after trauma), when neuromuscular connections have already been severely compromised.
The Study: Comparing Cells and Molecules
The researchers involved 15 patients, divided into two groups:
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one group received a local injection of UC-MSCs from umbilical cord tissue;
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the other group received the secretome, i.e., the molecules released by UC-MSCs in culture, without live cells.
Both treatments were administered directly at the junction between the median nerve and the flexor digitorum superficialis muscle (NMJ), during the intercostal nerve transfer procedure.
Results: Clinical but Not Histological Improvements
Eight months after surgery, patients were reassessed through:
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quality-of-life questionnaires (SF-36),
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the DASH scale (Disabilities of the Arm, Shoulder and Hand),
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muscle strength evaluation,
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biopsies for histological analysis.
Key findings:
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both groups showed significant improvements in quality of life, pain, emotional well-being, and physical and social function;
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the UC-MSC group reported a stronger perception of “health change” compared to the secretome group;
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however, histological analysis revealed no significant changes in inflammation, regeneration, or fibrosis, neither within groups nor between them.
What Does This Mean?
Stem cells – or their molecular derivatives – appear to enhance clinical recovery and improve patients’ quality of life, likely through paracrine effects: releasing molecules that reduce inflammation, modulate the local environment, and support nerve–muscle communication.
However, to achieve true structural regeneration of nerve and muscle tissue, additional strategies may be required, such as biomaterial scaffolds, electrical stimulation, or combined therapies.
A New Frontier in Regenerative Medicine
This study shows that cellular biotechnologies do not replace surgery but can boost its effectiveness and improve the patient’s recovery experience. Even in chronic nerve injuries, umbilical cord stem cells – when safely preserved – may become valuable tools for tissue repair, opening the way to a new era of regenerative medicine.
Source: Widodo W. et al. Functional outcome and histologic analysis of late onset total type brachial plexus injury treated with intercostal nerve transfer to median nerve with local umbilical cord-derived mesenchymal stem cells or secretome injection: a double-blinded, randomized control study. Eur J Orthop Surg Traumatol. 2024 Dec;34(8):4073-4082. PMID: 39382636, PMCID: PMC11519161
