By J.M. Ramselaar
In guy and a few of the apes, the thumb has the functionality of a contra finger. This functionality is made attainable by way of a good freedom of circulate of the 1st metacarpal and a hugely built and differentiated thumb musculature. The grab functionality of the hand depends at the oppositional means and adductive strength of the thumb, and is significantly constrained by way of a paralysis or disorder of the intrinsic thumb muscle mass. while lack of the functionality of the adductor pollicis could be partly compensated for by way of the adductive motion of the extensor pollicis longus, in paralysis or disorder of the radial thenar muscle mass reimbursement can in simple terms be supplied through surgical procedure. in view that 1918, many tools of tendon move were defined for the recovery of thumb competition, all of which result in an development of the clutch functionality, albeit to various levels. those equipment range within the collection of the motor, the path of pull of the tendon, using a fulcrum, and the mode of insertion. The powerful approach to Bunnell (1938) is frequently used because the regular technique. With this technique, the flexor superficialis tendon of the hoop finger is looped round the tendon of the flexor carpi ulnaris and handed subcutaneously around the thenar eminence, and then it truly is fastened at the thumb on the point of the metacarpo-phalangeal joint.
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Additional info for Tendon Transfers to Restore Opposition of the Thumb
Example text
The patient had no paresthesia or aching discomfort, even when manual pressure was applied on the transverse carpal ligament. The ninhydrin finger-printing and the two-point discrimination tests did not reveal any anomalies. Thus, there was an incomplete paralysis of intrinsic muscles as the result of a compression trauma, the function of the hypothenar muscles remaining completely intact. The findings were confirmed by the electromyographic investigation. ), that of the ulnar nerve was normal.
The abduction component is small in this case. In Camitz's method, which does not make use of a pulley, at the neutral position of the wrist joint a pure abduction of the first metacarpal is obtained. With an ulnar deviation of the hand, the direction of the palmaris longus tendon runs parallel with that of the abductor brevis fibres and a flexion component is added. Pressure or friction at the site of the pulley leads to a loss of effective power, the loss being greater the shorter the angle at which the tendon is bent.
Restoration of opposition by abductor digiti quinti transfer. Fig. 8. Result of the reconstruction. Fig. 8 56 DISCUSSION transfer route, normal passive mobility of the thumb with adequate stability in the metacarpo-phalangeal joint, and no restriction in the choice of a motor. It made little difference whether a superficial finger flexor, a wrist extensor, or the abductor digiti quinti was taken as motor. Since recovery of the opposition, or rather of the capacity for precision handling, was of primary importance for this patient, and the action of the radial thenar muscle can be compensated for most effectively by an intrinsic muscle participating in opposition, preference was given in this case to the reconstruction according to Huber and Nicolaysen.