Skip to main content
SpringerLink
Log in

Motor Loss

  • Chapter
  • First Online:
The Thumb

  • 776 Accesses

Abstract

The thumb dynamically allows for precision pinching and power gripping movements. These thumb motions are facilitated through the coordination of intrinsic thenar and extrinsic musculatures. Therefore, when the thenar muscles are paralyzed, the balance of the hand is disrupted as well as loss of power to perform principal function of the thumb. The most important function of the thumb is opposition to the other fingers because thumb opposition is necessary for both of the precision pinching and power gripping movements of the hand, whereas thumb adduction provides forceful grip by stabilizing the thumb in the desired position. Therefore, when the adductor pollicis is paralyzed as noted in ulnar nerve palsy, powerful grip is impossible. The tendon transfers to restore thumb motor function have the potential to greatly improve hand function and the patient’s well-being and ability to pursue a “normal” life. However, several critical issues must be considered before tendon transfer is underwent. In this chapter, the principles of the tendon transfer and detailed surgical techniques for thumb reconstruction after thumb motor loss were described.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kaplan EB, editor. Kaplan’s functional and surgical anatomy of the hand. 3rd ed. Philadelphia: J.B. Lippincott; 1984.

    Google Scholar 

  2. Davis TRC, editor. Principles of tendon transfers of median, radial, and ulnar nerve. 7th ed. Philadelphia: Elsevier; 2017.

    Google Scholar 

  3. Naeem R, Lahiri A. Modified camitz opponensplasty for severe thenar wasting secondary to carpal tunnel syndrome: case series. J Hand Surg. 2013;38(4):795–8.

    Article  Google Scholar 

  4. Bunnell S. Opposition of the thumb. J Bone Jt Surg Am. 1938;20:269–84.

    Google Scholar 

  5. Posner MA, Kapila D. Restoration of opposition. Hand Clin. 2012;28(1):27–44.

    Article  Google Scholar 

  6. Littler JW, Li CS. Primary restoration of thumb opposition with median nerve decompression. Plast Reconstr Surg. 1967;39(1):74–5.

    Article  CAS  Google Scholar 

  7. Chadderdon RC, Gaston RG. Low median nerve transfers (opponensplasty). Hand Clin. 2016;32(3):349–59.

    Article  Google Scholar 

  8. Rowntree T. Anomalous innervation of the hand muscles. J Bone Joint Surg Br. 1949;31B(4):505–10.

    Article  CAS  Google Scholar 

  9. Paternostro-Sluga T, Grim-Stieger M, Posch M, Schuhfried O, Vacariu G, Mittermaier C, Bittner C, Fialka-Moser V. Reliability and validity of the Medical Research Council (MRC) scale and a modified scale for testing muscle strength in patients with radial palsy. J Rehabil Med. 2008;40(8):665–71.

    Article  Google Scholar 

  10. Wilbur D, Hammert WC. Principles of tendon transfer. Hand Clin. 2016;32(3):283–9.

    Article  Google Scholar 

  11. Beasley RW. Principles of tendon transfer. Orthop Clin North Am. 1970;1(2):433–8.

    CAS  PubMed  Google Scholar 

  12. Brown PW. Adduction–flexion contracture of the thumb. Correction with dorsal rotation flap and release of contracture. Clin Orthop Relat Res. 1972;88:161–8.

    Article  CAS  Google Scholar 

  13. Curtis RM. Opposition of the thumb. Orthop Clin North Am. 1974;5(2):305–21.

    CAS  PubMed  Google Scholar 

  14. Leung PC, Hui KM. The thumb web expanding splint: dynamic splintage for traumatic web contracture. Hand. 1981;13(3):311–7.

    Article  CAS  Google Scholar 

  15. Mutz SB. Thumb web contracture. Hand. 1972;4(3):236–46.

    Article  CAS  Google Scholar 

  16. Hirshowitz B, Karev A, Rousso M. Combined double Z-plasty and Y-V advancement for thumb web contracture. Hand. 1975;7(3):291–3.

    Article  CAS  Google Scholar 

  17. Sandzen SC Jr. Dorsal pedicle flap for resurfacing a moderate thumb-index web contracture release. J Hand Surg. 1982;7(1):21–4.

    Article  Google Scholar 

  18. Mahmoud M, Abdel-Ghani H, Elfar JC. New flap for widening of the web space and correction of palmar contracture in complex clasped thumb. J Hand Surg. 2013;38(11):2251–6.

    Article  Google Scholar 

  19. Wang QR. [Correction of congenital adduction flexion deformity of the thumb by release of soft tissue contracture and rotating wedge osteotomy of the metacarpal bone]. Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi. 1988;4(3):193–4.

    Google Scholar 

  20. Goldner JL, Clippinger FW. Excision of the greater multangular bone as an adjunct to mobilization of the thumb. J Bone Joint Surg Am. 1959;41-A(4):609–25.

    Article  CAS  Google Scholar 

  21. Terrono AL, Rose JH, Mulroy J, Millender LH. Camitz palmaris longus abductorplasty for severe thenar atrophy secondary to carpal tunnel syndrome. J Hand Surg. 1993;18(2):204–6.

    Article  CAS  Google Scholar 

  22. Gonzalez MH, Weinzweig N, Kay T, Grindel S. Anatomy of the extensor tendons to the index finger. J Hand Surg. 1996;21(6):988–91.

    Article  CAS  Google Scholar 

  23. Taylor J, Casaletto JA. Absence of extensor indicis tendon complicating reconstruction of the extensor pollicis longus. J Hand Surg Eur Vol. 2017;42(5):528–9.

    Article  CAS  Google Scholar 

  24. Anderson GA, Lee V, Sundararaj GD. Opponensplasty by extensor indicis and flexor digitorum superficialis tendon transfer. J Hand Surg. 1992;17(6):611–4.

    Article  CAS  Google Scholar 

  25. Thomas LI, Thompson TC, Straub LR. Transplantation of the external oblique muscle for abductor paralysis. J Bone Joint Surg Am. 1950;32A(1):207–17, illust.

    Article  CAS  Google Scholar 

  26. Koo CC, Roberts AH. The palmaris longus tendon. Another variation in its anatomy. J Hand Surg. 1997;22(1):138–9.

    Article  CAS  Google Scholar 

  27. Caughell KA, McFarlane RM, McGrouther DA, Martin AH. Developmental anatomy of the palmar aponeurosis and its relationship to the palmaris longus tendon. J Hand Surg. 1988;13(4):485–93.

    Article  CAS  Google Scholar 

  28. Rymer B, Thomas PB. The Camitz transfer and its modifications: a review. J Hand Surg Eur Vol. 2016;41(6):632–7.

    Article  CAS  Google Scholar 

  29. Kang SW, Chung YG, Lee JY, Jo WL. Modified camitz opponensplasty using transverse carpal ligament loop pulley in patients with advanced carpal tunnel syndrome. Plast Reconstr Surg. 2012;129(4):761e–3e.

    Article  CAS  Google Scholar 

  30. Mondelli M, Reale F, Padua R, Aprile I, Padua L. Clinical and neurophysiological outcome of surgery in extreme carpal tunnel syndrome. Clin Neurophysiol. 2001;112(7):1237–42.

    Article  CAS  Google Scholar 

  31. Schneider LH. Opponensplasty using the extensor digiti minimi. J Bone Jt Surg Am. 1969;51(7):1297–302.

    Article  CAS  Google Scholar 

  32. Dunlap J, Manske PR, McCarthy JA. Perfusion of the abductor digiti quinti after transfer on a neurovascular pedicle. J Hand Surg. 1989;14(6):992–5.

    Article  CAS  Google Scholar 

  33. Uysal AC, Alagoz MS, Tuccar E, Sensoz O, Tekdemir I. The vascular anatomy of the abductor digiti minimi and the flexor digiti minimi brevis muscles. J Hand Surg. 2005;30(1):172–6.

    Article  Google Scholar 

  34. Goldner JL. Tendon transfers for irreparable peripheral nerve injuries of the upper extremity. Orthop Clin North Am. 1974;5(2):343–75.

    CAS  PubMed  Google Scholar 

  35. Smith RJ. Extensor carpi radialis brevis tendon transfer for thumb adduction—a study of power pinch. J Hand Surg. 1983;8(1):4–15.

    Article  CAS  Google Scholar 

  36. Edgerton MT, Brand PW. Restoration of abduction and adduction to the unstable thumb in median and ulnar paralysis. Plast Reconstr Surg. 1965;36:150–64.

    Article  CAS  Google Scholar 

  37. Zweig J, Rosenthal S, Burns H. Transfer of the extensor digiti quinti to restore pinch in ulnar palsy of the hand. J Bone Jt Surg Am. 1972;54(1):51–9.

    Article  CAS  Google Scholar 

  38. Omer GE. Tendon transfers for combined traumatic nerve palsies of the forearm and hand. J Hand Surg. 1992;17(6):603–10.

    Article  CAS  Google Scholar 

  39. Fischer T, Nagy L, Buechler U. Restoration of pinch grip in ulnar nerve paralysis: extensor carpi radialis longus to adductor pollicis and abductor pollicis longus to first dorsal interosseus tendon transfers. J Hand Surg. 2003;28(1):28–32.

    Article  CAS  Google Scholar 

  40. Hirayama T, Atsuta Y, Takemitsu Y. Palmaris longus transfer for replacement of the first dorsal interosseous. J Hand Surg. 1986;11(1):84–6.

    Article  CAS  Google Scholar 

  41. Robinson D, Aghasi MK, Halperin N. Restoration of pinch in ulnar nerve palsy by transfer of split extensor digiti minimi and extensor indicis. J Hand Surg. 1992;17(6):622–4.

    Article  CAS  Google Scholar 

  42. Alnot JY, Masquelet A. Restoration of thumb-index pinch by a double tendon transfer following ulnar nerve paralysis. Ann Chir Main. 1983;2(3):202–10.

    Article  CAS  Google Scholar 

  43. Neviaser RJ, Wilson JN, Gardner MM. Abductor pollicis longus transfer for replacement of first dorsal interosseous. J Hand Surg. 1980;5(1):53–7.

    Article  CAS  Google Scholar 

  44. Anderson GA, Lee V, Sundararaj GD. Extensor indicis proprius opponensplasty. J Hand Surg. 1991;16(3):334–8.

    Article  CAS  Google Scholar 

  45. Burkhalter W, Christensen RC, Brown P. Extensor indicis proprius opponensplasty. J Bone Jt Surg Am. 1973;55(4):725–32.

    Article  CAS  Google Scholar 

  46. de Kraker M, Selles RW, Zuidam JM, Molenaar HM, Stam HJ, Hovius SE. Outcome of flexor digitorum superficialis opponensplasty for Type II and IIIA thumb hypoplasia. J Hand Surg Eur Vol. 2016;41(3):258–64.

    Article  Google Scholar 

  47. Jacobs BTT. Opposition of the thumb and its restoration. J Bone Joint Surg Am. 1960;42(A):12.

    Google Scholar 

  48. Jensen EG. Restoration of opposition of the thumb. Hand. 1978;10(2):161–7.

    Article  CAS  Google Scholar 

  49. Foucher G, Malizos C, Sammut D, Braun FM, Michon J. Primary palmaris longus transfer as an opponensplasty in carpal tunnel release. A series of 73 cases. J Hand Surg. 1991;16(1):56–60.

    Article  CAS  Google Scholar 

  50. Park IJ, Kim HM, Lee SU, Lee JY, Jeong C. Opponensplasty using palmaris longus tendon and flexor retinaculum pulley in patients with severe carpal tunnel syndrome. Arch Orthop Trauma Surg. 2010;130(7):829–34.

    Article  Google Scholar 

  51. Wissinger HA, Singsen EG. Abductor digiti quinti opponensplasty. J Bone Jt Surg Am. 1977;59(7):895–8.

    Article  CAS  Google Scholar 

  52. Koh S, Horii E, Hattori T. Flexor pollicis longus reconstruction using the palmaris longus in anterior interosseus nerve syndrome. Hand Surg. 2014;19(2):189–92.

    Article  Google Scholar 

  53. Solonen KA, Bakalim GE. Restoration of pinch grip in traumatic ulnar palsy. Hand. 1976;8(1):39–44.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hand and Microsurgery Division, Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea

    Jong-Pil Kim & Jae-Sung Yoo

  2. Department of Kinesiology and Medical Science, Graduate School, Dankook University, Cheonan, South Korea

    Jong-Pil Kim

Authors
  1. Jong-Pil Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jae-Sung Yoo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jong-Pil Kim .

Editor information

Editors and Affiliations

  1. W Institute for Hand and Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, W Hospital, Daegu, Korea (Republic of)

    Sang Hyun Woo

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kim, JP., Yoo, JS. (2019). Motor Loss. In: Woo, S. (eds) The Thumb. Springer, Singapore. https://doi.org/10.1007/978-981-10-4400-7_14

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-4400-7_14

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-4399-4

  • Online ISBN: 978-981-10-4400-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation