Outcome of flexor digitorum superficialis opponensplasty for Type II and IIIA thumb hypoplasia

2015 ◽  
Vol 41 (3) ◽  
pp. 258-264 ◽  
Author(s):  
M. de Kraker ◽  
R. W. Selles ◽  
J. M. Zuidam ◽  
H. M. Molenaar ◽  
H. J. Stam ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Transfer ◽  
Ring Finger ◽  
Metacarpophalangeal Joint ◽  
Pinch Strength ◽  
Type Ii ◽  
Flexor Digitorum Superficialis ◽  
Joint Stability ◽  
Type Iiia ◽  
Flexor Digitorum

This study reports on outcomes of the flexor digitorum superficialis tendon transfer from the ring finger in Type II and IIIA hypoplastic thumbs. We included 22 patients with 27 involved hands: 16 Type II thumbs and five Type IIIA treated by transfer and six non-operated Type II thumbs. The outcomes were assessed by range of motion, strength, sensibility, joint stability and patient/parent satisfaction. Compared with normative data, the range of motion was diminished in all patient groups. Opposition strength in operated Type II thumbs was significantly better than in non-operated thumbs. Grip strength, pinch strength, tripod strength and key pinch strength were approximately 50% of normal in Type II thumbs and 35% in Type IIIA thumbs. Metacarpophalangeal joint stability was restored in all operated Type II thumbs and in 40% of Type IIIA thumbs. We conclude that the flexor digitorum superficialis tendon transfer of the ring finger is a good functioning opponensplasty in both Type II and IIIA thumbs. The transfer provides excellent stability of the metacarpophalangeal joint in Type II thumbs. Level of Evidence: Level IV

Influence of the flexor digitorum superficialis tendon transfer on grip strength

2021 ◽  
pp. 175319342110612
Author(s):  
Angelina Garkisch ◽  
Stefanie Schmitt ◽  
Nicole Kim ◽  
Dagmar-C. Fischer ◽  
Karl-Josef Prommersberger ◽  
...  
Keyword(s):  
Grip Strength ◽  
Tendon Transfer ◽  
Ring Finger ◽  
Flexor Digitorum Superficialis ◽  
Force Transmission ◽  
Finger Forces ◽  
Middle Ring ◽  
Flexor Digitorum

The flexor digitorum superficialis tendon of the ring finger can be transferred to the thumb flexor. We followed ten patients after such a transfer for 5–128 months and measured grip strength and force transmission of the fingers and individual phalanges while the patients gripped 10-cm or 20-cm diameter cylinders. The grip strength of the middle, ring and little fingers was reduced when gripping the 10-cm cylinder, with a significantly larger decrease in the ring finger. With the 20-cm cylinder, grip forces of all fingers were almost identical, with slightly lower force of the ring finger and slightly higher forces in the index and small fingers. We conclude that after transfer of flexor digitorum superficialis tendon from a ring finger, grip strength of the ring finger is reduced. Finger forces are more hampered while gripping objects with smaller circumferences than large ones.

A Flexor Digitorum Superficialis Tenodesis Technique for Surgical Treatment of Finger PIP Joint Volar Plate Chronic Avulsion

2019 ◽  
Vol 24 (02) ◽  
pp. 195-201
Author(s):  
L. Rocchi ◽  
G. Merendi ◽  
L. Mingarelli ◽  
F. Mancino ◽  
A. Merolli
Keyword(s):  
Range Of Motion ◽  
Proximal Phalanx ◽  
Volar Plate ◽  
Flexor Digitorum Superficialis ◽  
Joint Stability ◽  
Bone Anchor ◽  
Active Motion ◽  
Pip Joint ◽  
Post Traumatic ◽  
Flexor Digitorum

Background: Chronic, post-traumatic, avulsion of the proximal interphalangeal (PIP) joint volar plate represents a disabling lesion. The purpose of this report is to describe a flexor digitorum superficialis (FDS) tenodesis using a mini-bone anchor inserted into the proximal phalanx, and its clinical outcome. Methods: 15 patients with chronic post-traumatic hyperextension instability of the PIP joint were treated surgically. From the first post-operative day patients were invited to start an early gradual joint active motion, wearing an extension block splint. Forty days after surgery, clinical evaluations were carried out, including: joint stability, pain and range of motion (ROM). The use of a circumferential splint was recommended for two further months, avoiding strenuous manual activities. The range of motion, time lost at work and the functional results were recorded six months after surgery. Results: At last follow up, 7 of the 13 reviewed patients presented an excellent functional recovery, with complete resolution of pain and stability with attainment of ROM comparable to the contralateral finger. The others 6 patients obtained good results, with remission of the functional impairment and pain, with either residual hyperextension or flexion contracture. There was one case of recurrence consecutively to a premature traumatic work-related activity. Conclusions: The FDS tenodesis via a bone anchor, combined with early active PIP joint protected motion, was shown in this study to be effective and reliable.

Opponensplasty by Extensor Indicis and Flexor Digitorum Superficialis Tendon Transfer

1992 ◽  
Vol 17 (6) ◽  
pp. 611-614 ◽  
Author(s):  
G. A. ANDERSON ◽  
V. LEE ◽  
G. D. SUNDARARAJ
Keyword(s):  
Median Nerve ◽  
Tendon Transfer ◽  
Ring Finger ◽  
Flexor Digitorum Superficialis ◽  
Nerve Paralysis ◽  
Lateral Incision ◽  
Oblique Incision ◽  
Flexor Digitorum

From 1977 to 1988, 166 patients with median nerve paralysis of varied aetiology underwent opponensplasty. In 50 of these the extensor indicis was used, and in 116 the flexor digitorum superficialis of the ring finger. An analysis of these hands showed that the EI opponensplasty was best in supple hands and FDS opponensplasty was more suitable for less pliable hands. There were fewer complications seen after FDS opponensplasty if the detachment of the donor tendon was done through a volar oblique incision rather than the conventional lateral incision.

Blauth II thumb hypoplasia: a management algorithm for the unstable metacarpophalangeal joint

2012 ◽  
Vol 37 (8) ◽  
pp. 745-750 ◽  
Author(s):  
P. Smith ◽  
B. Sivakumar ◽  
R. Hall ◽  
A. Fleming
Keyword(s):  
Functional Results ◽  
Metacarpophalangeal Joint ◽  
Senior Author ◽  
Type Ii ◽  
Flexor Digitorum Superficialis ◽  
Tertiary Referral ◽  
Management Algorithm ◽  
Thumb Hypoplasia ◽  
Web Space ◽  
Flexor Digitorum

Blauth Type II thumb hypoplasia is defined by first web space narrowing, deficiency of thenar musculature, and instability of the metacarpophalangeal joint (MCPJ). This instability can be uni-axial (type IIA) or multi-axial (type IIB). The aim of this study was to assess the results of treating type II thumb hypoplasia using an algorithm based on the type of instability present. Cases of uni-axial MCPJ laxity (type IIA) underwent stabilization as part of a flexor digitorum superficialis opposition transfer. Type IIB cases with multi-axial instability were treated with an MCPJ chondrodesis and an abductor digit minimi transfer for opposition. First web space release was achieved using a z-plasty approach in all patients. An analysis was carried out of all cases of type II thumb hypoplasia treated by the senior author within the setting of a tertiary referral children’s hospital over a 9 year period. Using our management algorithm, equivalent functional results were seen in each subgroup in terms of first web space release, MCPJ stabilization, and opposition.

Transfer of Extensor Carpi Radialis Longus or Brevis for Opponensplasty

1999 ◽  
Vol 24 (1) ◽  
pp. 50-53 ◽  
Author(s):  
G. H. BAEK ◽  
J. M. JUNG ◽  
W. J. YOO ◽  
M. S. CHUNG
Keyword(s):  
Tendon Transfer ◽  
Ring Finger ◽  
The Other ◽  
Flexor Digitorum Superficialis ◽  
Flexor Muscles ◽  
Flexor Digitorum ◽  
Extensor Carpi Radialis

For the restoration of thumb opposition many types of tendon transfer techniques have been described. The flexor digitorum superficialis (FDS) of the ring finger is commonly selected as a motor. On occasion, however, the quality of the flexor muscles of the fingers or wrist is not good enough for tendon transfer and another available muscle must be selected. In this situation, we have preferred to use an extensor carpi radialis longus (ECRL) or brevis (ECRB) transfer to restore opposition of the thumb. Follow-up examination, at an average 5 years and 10 months after operation, showed that the results of ten of 11 transfers were excellent and the other was good.

scholarly journals Wide-Awake Approach for Flexor Digitorum Superficialis Tendon Transfer Followed by Early Active Mobilization

2021 ◽  
Author(s):  
Takuma Kuroda ◽  
Koji Moriya ◽  
Naoto Tsubokawa ◽  
Hiroko Narisawa ◽  
Yutaka Maki ◽  
...  
Keyword(s):  
Tendon Transfer ◽  
Ring Finger ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Active Motion ◽  
Standard Clinical Practice ◽  
Closed Rupture ◽  
Active Mobilization ◽  
Flexor Digitorum ◽  
Wide Awake

Abstract Background The standard clinical practice to treat closed ruptures of the flexor digitorum profundus (FDP) tendons includes free tendon grafting; however, it is not suitable when the muscle amplitude of the ruptured FDP is not sufficient. We report outcomes of six patients who underwent flexor digitorum superficialis (FDS) tendon transfer of the ring finger using the wide-awake approach to repair the closed rupture of the FDP tendon of the little finger in zone 3 or 4. Methods The patients were identified by reviewing our institutional billing records from January 2012 to October 2019 for the International Classification of Disease 10 code M66.3 that describes the diagnosis as “spontaneous rupture of flexor tendons.” Results The patients comprised two men and four women with an average age of 72.2 years (standard deviation [SD], 8.4 years). All patients were hospitalized after surgery to undergo early active mobilization. The average total active motion at the final evaluation was 201.8° (range: 85–248°). According to Strickland’s criteria, outcomes were excellent for two, good for three, and poor for one patient. No patients complained about the ring finger. Conclusion These results suggest that FDS tendon transfer is recommended when the muscle amplitude of the ruptured FDP is insufficient. We believe that the wide-awake approach and early active mobilization may contribute to satisfactory outcomes.

Bilateral Opponens Replacement in Post Polio Thenar Paralysis, Using Different Techniques. A Case Report.

HAND ◽  
1983 ◽  
Vol os-15 (2) ◽  
pp. 221-222 ◽  
Author(s):  
J. G. Andersen ◽  
J. W. Brandsma
Keyword(s):  
Case Report ◽  
Ring Finger ◽  
Flexor Digitorum Superficialis ◽  
Left Hand ◽  
Right Hand ◽  
Abductor Digiti Minimi ◽  
The Right ◽  
Flexor Digitorum

A patient is presented with bilateral thenar paralysis, due to poliomyelitis. On the right hand a successful abductor digiti minimi transfer was performed. On the left hand weakness of the hypothenar muscles prevented a good result. Subsequently an opponens replacement, using flexor digitorum superficialis from the ring finger, yielded a good result.

A detailed analysis of long-term outcomes following reconstruction for congenital thumb hypoplasia

2021 ◽  
pp. 175319342110446
Author(s):  
Konrad Mende ◽  
José Annelie Suurmeijer ◽  
Will T.M. Mason ◽  
Belinda J. Smith ◽  
Michael A. Tonkin
Keyword(s):  
Metacarpophalangeal Joint ◽  
Flexor Digitorum Superficialis ◽  
Long Term Outcomes ◽  
Level Of Evidence ◽  
Local Tissue ◽  
Thumb Hypoplasia ◽  
Abductor Digiti Minimi ◽  
Global Strength ◽  
Flexor Digitorum

This retrospective study analyses long-term outcomes of reconstruction for congenital thumb hypoplasia Grades 2 and 3 A. In 22 thumbs (mean follow-up 9 years), instability of the metacarpophalangeal joint was found in 20 thumbs regardless of the method of reconstruction, double breasting of local tissue with or without adductor pollicis advancement or use of a slip of flexor digitorum superficialis to supplement local tissue. There was a trend towards a greater global strength, higher Kapandji score and better subjective function score when the abductor digiti minimi was used as an opposition transfer as compared with the flexor digitorum superficialis. Results for motion and subjective parameters were consistent with comparable studies though these comparisons are compromised by different methods of classification and assessment. Consistent application of an expanded Blauth grading system and a formal hypoplastic thumb score will improve the ability to compare pre- and postoperative status, different techniques and results from different centres. Level of evidence: IV

OPPONOPLASTY WITHOUT POSTOPERATIVE IMMOBILIZATION

Hand Surgery ◽  
2011 ◽  
Vol 16 (03) ◽  
pp. 295-300 ◽  
Author(s):  
Ichiro Okutsu ◽  
Ikki Hamanaka ◽  
Aya Yoshida
Keyword(s):  
Muscle Function ◽  
Tendon Transfer ◽  
Proximal Phalanx ◽  
Ring Finger ◽  
Outpatient Basis ◽  
Reconstructive Procedure ◽  
Thenar Muscle ◽  
Pneumatic Tourniquet ◽  
Palmaris Longus Tendon ◽  
Flexor Digitorum

Opponoplasty using tendon transfer is a useful reconstructive procedure that restores lost thenar muscle function. Tendon transfers, however, require postoperative immobilization periods of up to four weeks before the sutured tendons reach required strength. We developed an opponoplasty procedure using α-TCP (alpha-tricalcium phosphate) cement that does not require postoperative immobilization and was applied to nine hands out of nine cases. The procedure is performed under local anesthesia without a pneumatic tourniquet and on an outpatient basis. In this procedure, the flexor digitorum superficialis of the ring finger is used as the donor tendon and the palmaris longus tendon is used as a dynamic pulley. The distal end of the transferred tendon is anchored to the inside of a newly formed bone hole in the thumb's proximal phalanx using α-TCP cement. Our opponoplasty procedure was uneventful postoperatively and produced satisfactory results in all nine cases. The α-TCP cement procedure shows potential for other tendon transfer applications.

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