Reconstruction of thumb opposition using tendon transfer

• Published in: Orthopedics & Traumatology Vol. 42; no. 3; pp. 1168 - 1171
• Main Authors: Kitashiro, Takeshi, Arakaki, Akira, Tazaki, Noriaki, Futenma, Chojo, Moriyama, Tomohiro, Kanaya, Fuminori, Ibaraki, Kunio, Kiyama, Katsuhiko
• Format: Journal Article
• Language: English
• Published: West-Japanese Society of Orthopedics & Traumatology 1993
• Subjects: carpal tunnel syndrome; hypoplastic thumb; opponoplasty; tendon transfer
• ISSN: 0037-1033; 1349-4333
• DOI: 10.5035/nishiseisai.42.1168

We reviewed 28 opponoplasties in 26 cases. Eight cases of carpal tunnel syndrome (CTS) received Camitz procedure in 4 cases and another four received tendon grafts. Six median nerve injuries accompanied with five flexor tendon lacerations received various tendon transfers. Huber procedure was carried out in three congenital anomalies, tendon transfers were done in two, and a free abductor hallucis M-C flap transfer was performed in one other case. Five cervical spinal cord injuries and brachial plexus injuries received a modified Makin procedure in which a rerouted FPL was sutured with the brachioradialis tendon. Three other cases received other tendon transfers. Result was evaluated by thumb palm distance (TPD: 83±7mm in healthy volunteer) and by stage according to Kapandji. In the cases with CTS, average TPD recovered to 76mm and stage improved to be better than 9. In cases with median nerve injury, average TPD recovered to 67mm when the tendon was sutured at the thumb MP joint and average TPD recovered to 56mm when the tendon was sutured at the wrist where scar from the initial injury was present. In cases of congenital anomalies, all but one thumb recovered to better than stage 6. Five hands which received Makin procedures showed poor opposition by adhesion. We concluded that nearly normal opposition can be expected in the CTS group by opponoplasty, transferred tendon should be repaired at thumb MP joint when previous scar exists at the wrist, expected opposition was not achieved using the modified Makin procedure.