Abductor Digit Minimi Opponensplasty: Technique, Modifications, and Measurement of Opposition

Abstract

The abductor digiti minimi is one of several muscles described as transfers for restoration of thumb opposition, a critically important function. This operation, also known as the Huber opponensplasty, is most commonly used for reconstruction of opposition in children with type 2 or 3a thumb deficiency, when it is often combined with Z-plasty of the thumb-index web space and metacarpophalangeal ulnar collateral ligament reconstruction. In our experience this operation reliably improves thumb opposition for children with this thumb deficiency.

Outcome After Pollicization for Congenital Thumb Deficiency: A Cohort Study of Cases in a Single Unit, 1987 to 2016

“…We have performed the Huber opponensplasty in 2 of the study participants based on their follow-up results. 39,40 Thumb sensitivity, length, and rotation were satisfactory in almost all cases. The girth was less than in normal thumbs in all cases, as Goldfarb et al 38 previously has demonstrated.…”

The Snow-Fink Technique as an Opposition Tendon Transfer for Children Born with a Hypoplastic or Absent Thumb

“…We determined that the most pertinent assessment of opposition was the modified Kapandji scale [9, 12]. In this modified scale, a score of 2 is given if the thumb pad can oppose to the index finger pad.…”

“…Several opposition transfers have been described in children—the abductor digiti minimi (ADM—Huber transfer) [5, 8, 9, 13–15, 20, 21], extensor pollicis longus (EPL) [18], palmaris longus (Camitz transfer) [9], and the flexor digitorum superficialis (FDS) [19]. Of all these techniques, the Huber transfer seems to be the most frequently used.…”

Revision of Carpal Tunnel Surgery

“…The motor deficit of chronic carpal tunnel syndrome primarily consists of thenar wasting and weakness with thumb opposition. There are several tendon transfers described for reconstructing thumb opposition including the abductor digiti minimi (Huber) [ 105 ], extensor indicis proprius (Burkhalter) ( Figure 8 ) [ 106 , 107 ], flexor digitorum superficialis ( Figure 9 ) [ 108 , 109 ], and the palmaris longus (Camitz) transfer [ 110 , 111 , 112 ]. Although there is no literature supporting the superiority of any of these transfers compared to the others, the Camitz palmaris longus transfer is most commonly selected (out choice as well) for severe carpal tunnel syndrome because of its simplicity, minimal donor morbidity, and access through the same revision carpal tunnel exposure.…”