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

Bertelli, Jayme Augusto; Soldado, Francisco; Rodrígues-Baeza, Alfonso; Ghizoni, Marcos Flávio

doi:10.1016/j.jhsa.2018.09.010

Cited by 27 publications

(20 citation statements)

References 34 publications

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“…2.5 SD from the means) of patients with an ulnar nerve injury will have a subterminal key-pinch strength less than the mean of the normal hand (Magnusson, 2020). This dramatic loss of subterminal key-pinch strength is reflected in the major complaint of thumb weakness and the need for reconstruction in patients who have suffered an ulnar nerve injury (Bertelli, 2019; Bertelli et al., 2019). In the series of 49 ulnar nerve repair patients described by Mitz et al.…”

Section: Discussionmentioning

confidence: 99%

“…We measured the bulk of the first web space bilaterally using a millimetre scale on a digital fat caliper (Prime Med,São Paulo, Brazil). One jaw of the calliper was placed on the palm and the other over the FDI muscle, as previously reported (Bertelli et al., 2019).…”

Section: Methodsmentioning

confidence: 99%

“…The median nerve contributes 60% and 65% of grasping and key-pinch strengths, respectively (Bertelli et al., 2016). To obtain more specific pinch measurements in the assessment of ulnar nerve function, dynamometry during a pinch-to-zoom gesture has been proposed (Bertelli et al., 2019). Pinch-to-zoom is the multi-touch gesture performed by the index and thumb for zooming in and out of a photo or other image on touch screens (Kim et al., 2014).…”

Section: Introductionmentioning

confidence: 99%

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Subterminal key pinch dynamometry: a new method to quantify strength deficit in ulnar nerve paralysis

Bertelli

2020

J Hand Surg Eur Vol

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Precise pre- and postoperative assessments are fundamental to recording the quality of recovery after ulnar nerve repair. Because of its imprecision, manual muscle testing is being replaced by dynamometry to measure grasping and key-pinch strengths. However, both grasping and key pinch are dependent not only on the ulnar nerve but also the median and radial nerves. We propose to measure strength using a new sort of pinch, called the ‘subterminal key pinch’. Strength was measured using a commercially available pinch meter. Patients applied pressure on the dynamometer with the interphalangeal joint of the thumb, maintaining the joint in extension to avoid enhancement of strength by the flexor pollicis longus. We examined 17 patients before ulnar nerve repair. Preoperatively, grasping strength was 46% of normal, while key pinch was 58%, pinch-to-zoom strength was 26% and subterminal key pinch only 7%. Subterminal key pinch was the most affected pinch with a strength deficit of over 90%. Level of evidence: IV

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Subterminal key pinch dynamometry: a new method to quantify strength deficit in ulnar nerve paralysis

Bertelli

2020

J Hand Surg Eur Vol

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“…However, practically the only way to restore intrinsic muscles and sensation in the hand is by nerve grafts and/or transfers. For example, intrinsic motor function can be restored by transfer of a median nerve branch to the ulnar nerve at the elbow, 63 and sensation can be restored by lateral antebrachial cutaneous to ulnar nerve transfer 64 with recoveries taking from six months to well over one year. Ultimately, the elbow is a vehicle for placing the hand in space, so preserving or restoring hand function is more important than achieving a particular quality of elbow movement.…”

Section: Distal Humerusmentioning

confidence: 99%

Reconstruction for bone tumours of the shoulder and humerus in children and adolescents

Hopyan

2021

Journal of Children's Orthopaedics

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Reconstructions for paediatric bone tumours of the shoulder girdle and humerus are intended to optimize placement of the hand in space. Given the longevity of paediatric survivors of sarcoma, durability is an important planning consideration. Here, I review a subset of approaches based on anatomical site with an emphasis on function and longevity. Often, biological reconstructions that combine living bone with tendon repairs and transfers best address those goals.

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“…Bertelli et al 6 successfully transferred the motor branch of the opponens pollicis (OP) to the terminal division of the deep branch of the ulnar nerve (TDDBUN) to reconstruct pinch in patients with ulnar nerve injuries around the elbow. We hypothesized that this technique could also be beneficial for a low ulnar nerve lesion in selected cases.…”

Section: Introductionmentioning

confidence: 99%

Bilateral Ulnar Nerve Injury in the Wrist: Comparison of First Webspace Muscle Reconstruction by Opponens Nerve Transfer in the Right Hand Versus Direct Ulnar Nerve Repair in the Left Hand

Bertelli

Hill

Arami

et al. 2022

Hand (New York, N,Y.)

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We report a case of a bilateral glass injury to the wrist with transection of flexor tendons and the ulnar nerve and artery in a 60-year-old male patient. Two days after his accident, we repaired all divided structures, and on the right hand, we added the transfer of the opponens motor branch to the deep terminal division of the ulnar nerve aimed at first dorsal interosseous and adductor pollicis muscle reinnervation. After surgery, the patient was followed over 24 months. Postoperative dynamometry of the hand, which included grasping, key-pinch, subterminal-key-pinch, pinch-to-zoom, and first dorsal interosseous muscle strength, indicated recovery only in the nerve transfer side.

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

Cited by 27 publications

References 34 publications

Subterminal key pinch dynamometry: a new method to quantify strength deficit in ulnar nerve paralysis

Subterminal key pinch dynamometry: a new method to quantify strength deficit in ulnar nerve paralysis

Reconstruction for bone tumours of the shoulder and humerus in children and adolescents

Bilateral Ulnar Nerve Injury in the Wrist: Comparison of First Webspace Muscle Reconstruction by Opponens Nerve Transfer in the Right Hand Versus Direct Ulnar Nerve Repair in the Left Hand

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