Flexor Digitorum Superficialis Opposition Transfer for Augmenting Function in Types II and IIIA Thumb Hypoplasia

Vuillermin, Carley; Butler, Lesley M.; Lake, Amy; Ezaki, Marybeth; Oishi, Scott N.

doi:10.1016/j.jhsa.2015.11.017

Cited by 19 publications

(25 citation statements)

References 20 publications

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“…For patients that returned for follow-up, clinical assessment was performed by a fellowship-trained upper extremity physician or a hand certified occupational therapist. Assessments included thumb range of motion, Kapandji score (1–10), stability of the radial and ulnar collateral ligaments of the MCP joint, and key pinch and tripod pinch strength. A Kapandji score of 1 indicated opposition of the thumb to the radial side of the proximal phalanx of the index finger and a 10 indicated opposition to the distal palmar crease (14).…”

Section: Methodsmentioning

confidence: 99%

“…Visual Analog Scale (VAS) scores were obtained from both the parent and the patient for pain, appearance, and function on a 10- point scale. A low VAS score (0–1) represented no pain, perfect appearance, and no problem with function; a high VAS score (10) was extreme pain, severe deformity, and very limited function. VAS scores were recorded for each thumb if there had been bilateral operations.…”

Section: Methodsmentioning

confidence: 99%

“…Manske noted that the extensor digiti minimi can abduct the little finger as well, partially negating any loss of function associated with the use of the ADQ (9). However, while a few studies have examined outcomes in patients who have undergone the FDS transfer for thumb opposition (10,11,12), studies focusing on long-term outcomes for patients having undergone the ADQ transfer are sparse. Furthermore, the studies that do examine outcomes incorporate a larger, mixed cohort composed of congenital patients as well as patients having loss of opposition due to traumatic injury (8,13).…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Outcomes of Huber Opposition Transfer for Augmenting Hypoplastic Thumb Function

Wall¹,

Patel²,

Roberts³

et al. 2017

The Journal of Hand Surgery

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Purpose This study was conducted to report the functional outcomes of the Huber opposition transfer (abductor digiti minimi muscle) in type II and IIIA hypoplastic thumbs. Methods Patients who had undergone a Huber opposition transfer with at least 5 years of follow-up were included in this study. There were 21 thumbs included; 12 returned for a detailed evaluation and 9 were included with a medical record review. Outcome measures included range of motion and pinch strength; PODCI and PROMIS scores were collected on those who could return. There were 15 type II and 6 IIIA thumbs. Results Range of motion was significantly less than normal for both the interphalangeal (IP) and metacarpophalangeal (MCP) joints. For the returning cohort, key and tripod pinch were 44% and 65% of normal. The median Kapandji score was 9 (range 6–10). PODCI scores were high for global, upper extremity function, happiness, and pain. PROMIS scores were similar to normal, except for parent reports of physical function. For all included patients, there was a revision surgery rate of 22%, primarily related to persistent instability. Conclusions The Huber opposition transfer for type II and IIIA thumbs was shown to provide good subjective outcomes, despite limited range of motion and strength, at a minimum 5-year follow-up. Type of study/level of evidence Therapeutic level IV.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long-Term Outcomes of Huber Opposition Transfer for Augmenting Hypoplastic Thumb Function

Wall¹,

Patel²,

Roberts³

et al. 2017

The Journal of Hand Surgery

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“…At this time, there are no reports of the outcomes of the Huber opposition transfer. Two studies have reported outcomes of the FDS opposition transfer for types II and IIIA hypoplastic thumbs (18,19). De Kraker et al assessed 27 thumbs, 21 that had undergone tendon transfer and 6 that were treated non-operatively.…”

Section: Discussionmentioning

confidence: 99%

“…Vuillermin et al reported on 40 thumbs at minimum 2 years follow-up and found grip and pinch strength was approximately 50% of normal and that overall perceived function and happiness was high. There was no difference between the different pulleys utilized and 36 of the thumbs underwent UCL reconstruction (19). Both studies reported increased stability of the thumb MP joints after reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Tendon Transfers for the Hypoplastic Thumb

Wall

Goldfarb

2016

Hand Clinics

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Article Synopsis Thumb hypoplasia is a component of radial longitudinal deficiency. The severity of hypoplasia can range from a slightly smaller thumb to a complete absence. Types II and IIIA hypoplastic thumbs are candidates for reconstruction to improve function, stability, and strength. There are two commonly used tendon transfers that can augment thumb opposition strength, the Huber abductor digiti minimi muscle transfer and flexor digitorum superficialis (FDS) opposition transfer. Both transfers utilize ulnar sided structures to augment the thenar musculature. The Huber opposition transfer increases thenar bulk, but does not provide additional tissue for metacarpophalangeal (MP) stability. In contrast, the FDS opposition transfer utilizes the flexor of the middle or ring finger to augment the thenar musculature without increasing bulk, but does have additional tendon to allow for reconstruction of the thumb MP joint.

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