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Clinical Example: Flexor Pollicis Brevis Opponensplasty
| There are several time honored procedures
for restoration of thumb abduction in median nerve palsy, including transfer
of the palmaris longus, superficial flexor, extensor indicis, extensor
digiti minimi, and others. This is a description of a new procedure, a
bipolar transfer of the superficial head of the flexor pollicis brevis
to the origin and insertion points of the the abductor pollicis brevis
muscle. The superficial head of the short thumb flexor, with ulnar nerve
innervation, provides thumb opposition in nearly half of patients with
low median nerve palsy. In a smaller percentage of patients with low median
nerve palsy, the short flexor maintains strength but does not provide opposition.
In this group of patients, flexor to abductor transfer may be a satisfactory
alternative, not requiring wrist immobilization and not dependent upon
tenodesis. |
| Click on each image
for a larger picture |
| Severe carpal tunnel syndrome with
complete thenar atrophy of several years duration. The flexor pollicis
brevis muscle was strong, but provided only weak abduction. |
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| Pale, atrophic, chronically denervated
pale abductor pollicis brevis lies superficial to the superficial head
of the flexor pollicis brevis. |
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| The origin and insertion of the superficial
component of the flexor pollicis brevis were transferred to the sites of
origin and insertion of the abductor pollicis brevis. |
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| One month postop, after being immobilized
in a hand based thumb spica splint, the transfer activates well. |
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