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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2009 April;60(2):181-4
Bilateral opponensplasty for low median nerve palsy
Berloco M., Azzarà A., Altissimi M.
Struttura Complessa Chirurgia della Mano e Microchirurgia, Azienda Ospedaliera Terni, Italia
Loss of thumb opposition is frequently observed in severe carpal tunnel syndrome, after median nerve trauma at the wrist level and after hyatrogenic injuries of the motor branch of the median nerve for the thenar muscles. A number of tendon transfers can be used to restore thumb opposition, that differ for direction, excursion and donor site impairment. Extensor indicis proprius transfer has been used to restore bilateral thumb opposition in a patient with a severe median nerve palsy. Results have been evaluated with a follow-up from six months to two years, comparing the pre- and postoperative values of palmar abduction, thumb opposition in the Kapandji scale, pinch and grip stength. A significant increase of all these clinical parameters has been observed in patient. No significant impairment of index finger independent extension has been noticed. In our experience extensor indicis proprius transfer is a reliable and successful operation to restore thumb opposition in low median nerve palsy.