Download Tendon Transfers to Restore Opposition of the Thumb by J.M. Ramselaar PDF

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 through a good freedom of move of the 1st metacarpal and a hugely constructed and differentiated thumb musculature. The snatch functionality of the hand depends at the oppositional ability and adductive strength of the thumb, and is critically restricted by way of a paralysis or disorder of the intrinsic thumb muscle mass. while lack of the functionality of the adductor pollicis may be partly compensated for through the adductive motion of the extensor pollicis longus, in paralysis or disorder of the radial thenar muscle tissues reimbursement can simply be supplied by means of surgical procedure. considering the fact that 1918, many equipment of tendon move were defined for the recovery of thumb competition, all of which lead to an development of the grab functionality, albeit to various levels. those tools differ within the choice of the motor, the course of pull of the tendon, using a fulcrum, and the mode of insertion. The powerful approach to Bunnell (1938) is frequently used because the common strategy. With this system, 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's mounted at the thumb on the point of the metacarpo-phalangeal joint.

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Extra resources for Tendon Transfers to Restore Opposition of the Thumb

Example text

The pinch power between the thumb and the index finger, as measured with the Vigorimeter *, was half that of the left hand. e. the joint was not hyperextended during the pinching action. The passive mobility of the thumb was normal. The sidewards movements of the middle and ring fingers were limited. The abduction of the little finger and the elevation of the hypothenar were normal. Remarkably enough, the sensibility was not disturbed. The patient had no paresthesia or aching discomfort, even when manual pressure was applied on the transverse carpal ligament.

The muscle has sufficient power for the restoration of opposition and can be transferred to the thumb without intervening pulley or gliding tendon. The weakened abduction of the little finger has relatively little importance for prehension. A certain amount of abduction will in any case remain possible due to the action of the extensor proprius and the flexor brevis of the little finger. It is hardly surprising that transposition of the abductor digiti quinti is one of the oldest methods for opposition reconstruction.

The more proximally the insertion is made, the smaller the lever arm of the RECONSTRUCTION OF THE OPPOSITION 35 muscle. This has the consequence that a greater muscular force and a smaller amplitude are required to achieve the same position of opposition, because work equals force times distance. Therefore, when only a powerful muscle with a limited amplitude is available for an opposition tendon transfer, this muscle should be inserted proximal to the first metacarpal, to make the most efficient use of power and amplitude.

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