Transferring the Motor Branch of the Opponens Pollicis to the Terminal Division of the Deep Branch of the Ulnar Nerve for Pinch Reconstruction.

PURPOSE

With ulnar nerve injuries, paralysis of the first dorsal interosseous (FDI) and the adductor pollicis (ADP) muscles weakens pinch. The likelihood that these muscles will be reinnervated following ulnar nerve repair around the elbow is very low. To overcome this obstacle, we propose a more distal repair: transferring the opponens pollicis motor branch (OPB) to the terminal division of the deep branch of the ulnar nerve (TDDBUN).

METHODS

We dissected 10 embalmed hands to study the anatomy of the thenar branches of the median nerve and TDDBUN. We also operated on 3 patients with recent ulnar nerve injuries around the elbow, suturing the ulnar nerve and transferring the OPB to the TDDBUN. Before and after surgery, we measured grasp, key pinch, and pinch-to-zoom strength using dynamometers. Pinch-to-zoom gesture consists of moving the index finger and thumb pulp toward each other for zooming out of an image on screen. Patients were followed for at least 15 months.

RESULTS

The thenar branch of the median nerve innervated the abductor pollicis brevis and opponens pollicis in all specimens, but only half the superficial head of the flexor pollicis brevis. The TDDBUN gave off a single motor branch to the transverse head of the ADP, 1 or 2 branches to the oblique head, and a final branch to the FDI. The ratio of myelinated fibers between the OPB and the TDDBUN was 3:5. Relative to the normal side, pinch-to-zoom strength was mostly affected by the ulnar nerve lesion, with strength decreased by 80% to 90%. After surgery, we observed reinnervation of the FDI and an 80% to 90% improvement in pinch-to-zoom strength.

CONCLUSIONS

Transferring the OPB to the TDDBUN provided reinnervation of the FDI and ADP, thereby contributing to pinch strength improvement.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.