Techniques for restoring thumb opposition require multiple incisions and frequently use non agonist muscles. We present our experience using an agonist muscle trough a single palmar approach.

Methods

We performed a retrospective review of all the cases treated in our center for loss of thumb opposition due to low median nerve palsy by transferring the palmaris longus end-to-end to the extensor pollicis brevis. A single transverse volar wrist incision is used which can serve also for carpal tunnel release. Tension was set with the wrist in neutral position and the thumb in full opposition. Patients wore a cast for four weeks and were referred to therapy afterwards. The evaluation system proposed by Mehta and Malaviya was used to assess the final results.

Results

Sixteen patients were treated with this technique. Indications consisted of severe carpal tunnel syndrome, brachial plexus injury, untreated low median nerve laceration, radiation neuropathy and tumors. Two out of the sixteen patients were industrial accidents; the remaining 14 were not work related. Average follow-up was 14 months (range: 12-18 months). At final follow-up, eleven patients had good and five fair results according to Mehta and Malaviya’s score. The two manual laborers were able to return to full duty activities in an average period of 12 weeks. None of the patients developed adhesions, infection or reflex sympathetic dystrophy. We did not have any ruptures of the transfer at final follow-up. .

Conclusion

Techniques that are currently used to address loss of opposition use more than one incision and donor tendons that are not agonists. This fact makes difficult the rehabilitation of such transfers. We introduce a simple surgical technique using a single volar incision, with minimal disruption of soft tissues, which uses an agonist donor for opposition and facilitates rehabilitation especially in elderly patients.