Simultaneous modified Camitz opponensplasty using a pulley at the radial side of the flexor retinaculum in severe carpal tunnel syndrome

Kato, Naoki; Yoshizawa, Takahiro; Sakai, Hiroya

doi:10.1177/1753193413498328

Cited by 28 publications

(50 citation statements)

References 17 publications

(30 reference statements)

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“…In thenar paralysis, restoration of function can be achieved by several surgical approaches involving PL tendon transfer to the insertion site of the abductor pollicis brevis to restore thumb abduction function (Camitz Opponensplasty) (Camitz, ; Rymer and Thomas, ). A modified approach to Camitz opponensplasty in treatment of severe carpal tunnel syndrome mobilizes the PL tendon through the radial or ulnar portion of the incised flexor retinaculum for use as a pulley for better approximation of pure opposition movements (Foucher et al ; Kato et al ; Littler and Li, ; Macdougal, ; Park et al ; Terrono et al ). Although the site of the PL insertion is transferred from the wrist to the interphalangeal joint of the first digit, patients require no specific rehabilitation perhaps due to an established neuromuscular facilitation, or synergy, already existing between the PL and abductor pollicis brevis (Kato et al ).…”

Section: Discussionmentioning

confidence: 99%

“…A modified approach to Camitz opponensplasty in treatment of severe carpal tunnel syndrome mobilizes the PL tendon through the radial or ulnar portion of the incised flexor retinaculum for use as a pulley for better approximation of pure opposition movements (Foucher et al ; Kato et al ; Littler and Li, ; Macdougal, ; Park et al ; Terrono et al ). Although the site of the PL insertion is transferred from the wrist to the interphalangeal joint of the first digit, patients require no specific rehabilitation perhaps due to an established neuromuscular facilitation, or synergy, already existing between the PL and abductor pollicis brevis (Kato et al ). Therefore, in other surgical interventions in which the ipsilateral PL is routinely harvested, such as ulnar collateral ligament reconstruction (Cain and Mathis, ), the role of the PL in palmar function should be considered based on its potential synergy with thenar musculature.…”

Section: Discussionmentioning

confidence: 99%

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Revisiting the functional anatomy of the palmaris longus as a thenar synergist

2017

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Surgical studies describe the palmaris longus (PL) as a synergist in thumb abduction, which may facilitate its use in restoring thumb function using opponensplasty. However, beyond morphological descriptions and isometric thenar abduction strength measures, the evidence supporting the PL as a thenar synergist in-vivo is limited. The purpose here was to determine whether the PL provides synergistic contributions to thenar musculature by: (1) recording PL muscle activity using indwelling electromyography (EMG) during thumb movements; and (2) quantifying changes in PL muscle architecture using ultrasonography. In 10 healthy males, PL muscle activity was recorded during maximal thenar muscle contractions (abduction, flexion, opposition, adduction, and extension) with the wrist secured in a neutral position. The PL EMG was normalized to its maximal EMG recorded during isometric wrist flexion. Dynamic changes in PL muscle thickness (M ) were determined during abduction and adduction using ultrasound imaging. The results indicate that the PL is activated during thenar movements with greatest relative PL EMG recorded during thenar abduction (46%), flexion (35%) and opposition (37%). Compared to rest, PL M significantly increased (21%) during maximal thenar abduction. With direct measures in vivo, this study supports morphological and surgical observations indicating the PL acts as an extrinsic hand muscle in enhancing thenar muscle actions. Knowledge of the synergistic relationship between the PL and thenar musculature may allow for further development of surgical opponensplasty approaches using the abductor pollicis brevis and PL as a functional digastric unit. Clin. Anat. 31:760-770, 2018. © 2017 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Revisiting the functional anatomy of the palmaris longus as a thenar synergist

2017

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“…The patients were included no matter whether opponensplasty was conducted or not. For the reconstruction surgery, a strip constructed from the palmar aponeurosis extending from the palmaris longus tendon was passed through a hole made in the radial remnant of the divided flexor retinaculum and attached not only to the APB tendon but to the extensor pollicis brevis tendon . This study was approved by the ethics committee of Teikyo University (Approval No.…”

Section: Methodsmentioning

confidence: 99%

Prognosis of severe carpal tunnel syndrome with absent compound muscle action potential

et al. 2016

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“…As such, thenar muscle wasting is not uncommon in patients with severe CTS. 6,7) The resulting muscle weakness together with loss of finger sensibility makes for a complex problem leading to disturbance of thumb prehension and hand dexterity.…”

Section: Discussionmentioning

confidence: 99%

Thumb Function and Electromyography Result after Modified Camitz Tendon Transfer

Durban

Antolin

et al. 2017

J Hand Surg Asian-Pac Vol

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Background: Various techniques of opponensplasty have been developed with the aim of restoring the thumb function. The modified Camitz opponensplasty is a simple technique done together with an open carpal tunnel release. It restores thumb palmar abduction soon after the procedure, during such time that the abductor pollicis brevis (APB) is still recovering. The aim of this study was to assess the recovery and level of activity of the abductor pollicis brevis and palmaris longus (PL) muscles during thumb opposition and abduction after performing the modified Camitz opponensplasty. Methods: The records of 21 patients who underwent modified Camitz opponensplasty for severe carpal tunnel syndrome were reviewed. Thumb function was evaluated using the Van Wetter Apogee test, Kapandji index, tripod pinch strength, and power grip. Electromyography was utilized to evaluate APB recovery; ultrasonography was employed to evaluate PL activity. Results: Twenty patients reached 80% of the abduction height of the contralateral hand; the Kapandji index was good in thirteen. Palmaris longus activity was evaluated together with the APB muscle recovery. There was significant improvement in the average grip strength and average tripod pinch strength. However, this did not correlate with the degree of neurologic and muscular recovery of the APB. We surmise that the palmaris longus augmented the abductor pollicis brevis muscle even in those with full muscle recovery. Conclusions: The modified Camitz opponensplasty is a practical option for patients suffering from severe carpal tunnel syndrome with diminished thumb function.

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Simultaneous modified Camitz opponensplasty using a pulley at the radial side of the flexor retinaculum in severe carpal tunnel syndrome

Cited by 28 publications

References 17 publications

Revisiting the functional anatomy of the palmaris longus as a thenar synergist

Revisiting the functional anatomy of the palmaris longus as a thenar synergist

Prognosis of severe carpal tunnel syndrome with absent compound muscle action potential

Thumb Function and Electromyography Result after Modified Camitz Tendon Transfer

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