A modification of the palmaris longus-to-extensor pollicis longus transfer for radial nerve palsy

Kensuke Ochi, Yukio Horiuchi, Takashi Matsumura, Kozo Morita, Yusuke Kawano, Koichi Horiuchi

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Purpose: The standard palmaris longus (PL)-to-rerouted extensor pollicis longus (EPL) transfer was modified by taking the PL with an extension of the palmar aponeurosis (PA) and performing the transfer at the level of the thumb metacarpal. Our purpose was to evaluate whether this modified transfer could restore both the extension and the radial abduction of the thumb without rerouting the EPL. Methods: We restored thumb function of 5 patients with unrecovered radial nerve palsy (4 men and 1 women; mean age at surgery, 47 years; mean duration between onset of palsy and surgery, 13 months; and mean follow-up period after surgery, 17 months). The PA was dissected in continuity with the PL (PA/PL) tendon, as is done in Camitz thumb opponensplasty. Another skin incision was made on the dorsal side of the thumb metacarpal, and the EPL tendon was exposed. The PA/PL tendon was drawn into this skin incision, passing under the abductor pollicis longus and extensor pollicis brevis tendons. The PA/PL tendon was woven into the undivided EPL tendon and immobilized for 3 weeks. Results: The mean values of active hyperextension and flexion of the interphalangeal joint, radial abduction, palmar abduction of the thumb, grip strength, and tip pinch strength of the involved/contralateral sides were 3°/7°, 41°/49°, 59°/65°, 65°/70°, 37 kg/47 kg, and 4.0 kg/5.2 kg, respectively. Discussion: We used the PA to lengthen the PL tendon, to transfer it to the EPL at a level distal to the Lister tubercle. Because our procedure is based on the concept of standard transfer, it should yield similar long-term results. Our procedure should be a good alternative, especially in cases of closed radial nerve injury, because it preserves the paralyzed EPL for possible future recovery. Type of study/level of evidence: Therapeutic IV.

Original languageEnglish
Pages (from-to)2357-2361
Number of pages5
JournalJournal of Hand Surgery
Volume37
Issue number11
DOIs
Publication statusPublished - 2012 Nov
Externally publishedYes

Fingerprint

Radial Nerve
Thumb
Paralysis
Tendons
Metacarpal Bones
Pinch Strength
Tendon Transfer
Skin
Hand Strength
Aponeurosis
Joints
Wounds and Injuries

Keywords

  • extensor pollicis longus
  • palmar aponeurosis
  • palmaris longus
  • radial nerve palsy
  • Tendon transfer

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Ochi, K., Horiuchi, Y., Matsumura, T., Morita, K., Kawano, Y., & Horiuchi, K. (2012). A modification of the palmaris longus-to-extensor pollicis longus transfer for radial nerve palsy. Journal of Hand Surgery, 37(11), 2357-2361. https://doi.org/10.1016/j.jhsa.2012.08.017

A modification of the palmaris longus-to-extensor pollicis longus transfer for radial nerve palsy. / Ochi, Kensuke; Horiuchi, Yukio; Matsumura, Takashi; Morita, Kozo; Kawano, Yusuke; Horiuchi, Koichi.

In: Journal of Hand Surgery, Vol. 37, No. 11, 11.2012, p. 2357-2361.

Research output: Contribution to journalArticle

Ochi, K, Horiuchi, Y, Matsumura, T, Morita, K, Kawano, Y & Horiuchi, K 2012, 'A modification of the palmaris longus-to-extensor pollicis longus transfer for radial nerve palsy', Journal of Hand Surgery, vol. 37, no. 11, pp. 2357-2361. https://doi.org/10.1016/j.jhsa.2012.08.017
Ochi, Kensuke ; Horiuchi, Yukio ; Matsumura, Takashi ; Morita, Kozo ; Kawano, Yusuke ; Horiuchi, Koichi. / A modification of the palmaris longus-to-extensor pollicis longus transfer for radial nerve palsy. In: Journal of Hand Surgery. 2012 ; Vol. 37, No. 11. pp. 2357-2361.
@article{1764e0d717ee4bdcb71eab97541ec0ac,
title = "A modification of the palmaris longus-to-extensor pollicis longus transfer for radial nerve palsy",
abstract = "Purpose: The standard palmaris longus (PL)-to-rerouted extensor pollicis longus (EPL) transfer was modified by taking the PL with an extension of the palmar aponeurosis (PA) and performing the transfer at the level of the thumb metacarpal. Our purpose was to evaluate whether this modified transfer could restore both the extension and the radial abduction of the thumb without rerouting the EPL. Methods: We restored thumb function of 5 patients with unrecovered radial nerve palsy (4 men and 1 women; mean age at surgery, 47 years; mean duration between onset of palsy and surgery, 13 months; and mean follow-up period after surgery, 17 months). The PA was dissected in continuity with the PL (PA/PL) tendon, as is done in Camitz thumb opponensplasty. Another skin incision was made on the dorsal side of the thumb metacarpal, and the EPL tendon was exposed. The PA/PL tendon was drawn into this skin incision, passing under the abductor pollicis longus and extensor pollicis brevis tendons. The PA/PL tendon was woven into the undivided EPL tendon and immobilized for 3 weeks. Results: The mean values of active hyperextension and flexion of the interphalangeal joint, radial abduction, palmar abduction of the thumb, grip strength, and tip pinch strength of the involved/contralateral sides were 3°/7°, 41°/49°, 59°/65°, 65°/70°, 37 kg/47 kg, and 4.0 kg/5.2 kg, respectively. Discussion: We used the PA to lengthen the PL tendon, to transfer it to the EPL at a level distal to the Lister tubercle. Because our procedure is based on the concept of standard transfer, it should yield similar long-term results. Our procedure should be a good alternative, especially in cases of closed radial nerve injury, because it preserves the paralyzed EPL for possible future recovery. Type of study/level of evidence: Therapeutic IV.",
keywords = "extensor pollicis longus, palmar aponeurosis, palmaris longus, radial nerve palsy, Tendon transfer",
author = "Kensuke Ochi and Yukio Horiuchi and Takashi Matsumura and Kozo Morita and Yusuke Kawano and Koichi Horiuchi",
year = "2012",
month = "11",
doi = "10.1016/j.jhsa.2012.08.017",
language = "English",
volume = "37",
pages = "2357--2361",
journal = "Journal of Hand Surgery",
issn = "0363-5023",
publisher = "W.B. Saunders Ltd",
number = "11",

}

TY - JOUR

T1 - A modification of the palmaris longus-to-extensor pollicis longus transfer for radial nerve palsy

AU - Ochi, Kensuke

AU - Horiuchi, Yukio

AU - Matsumura, Takashi

AU - Morita, Kozo

AU - Kawano, Yusuke

AU - Horiuchi, Koichi

PY - 2012/11

Y1 - 2012/11

N2 - Purpose: The standard palmaris longus (PL)-to-rerouted extensor pollicis longus (EPL) transfer was modified by taking the PL with an extension of the palmar aponeurosis (PA) and performing the transfer at the level of the thumb metacarpal. Our purpose was to evaluate whether this modified transfer could restore both the extension and the radial abduction of the thumb without rerouting the EPL. Methods: We restored thumb function of 5 patients with unrecovered radial nerve palsy (4 men and 1 women; mean age at surgery, 47 years; mean duration between onset of palsy and surgery, 13 months; and mean follow-up period after surgery, 17 months). The PA was dissected in continuity with the PL (PA/PL) tendon, as is done in Camitz thumb opponensplasty. Another skin incision was made on the dorsal side of the thumb metacarpal, and the EPL tendon was exposed. The PA/PL tendon was drawn into this skin incision, passing under the abductor pollicis longus and extensor pollicis brevis tendons. The PA/PL tendon was woven into the undivided EPL tendon and immobilized for 3 weeks. Results: The mean values of active hyperextension and flexion of the interphalangeal joint, radial abduction, palmar abduction of the thumb, grip strength, and tip pinch strength of the involved/contralateral sides were 3°/7°, 41°/49°, 59°/65°, 65°/70°, 37 kg/47 kg, and 4.0 kg/5.2 kg, respectively. Discussion: We used the PA to lengthen the PL tendon, to transfer it to the EPL at a level distal to the Lister tubercle. Because our procedure is based on the concept of standard transfer, it should yield similar long-term results. Our procedure should be a good alternative, especially in cases of closed radial nerve injury, because it preserves the paralyzed EPL for possible future recovery. Type of study/level of evidence: Therapeutic IV.

AB - Purpose: The standard palmaris longus (PL)-to-rerouted extensor pollicis longus (EPL) transfer was modified by taking the PL with an extension of the palmar aponeurosis (PA) and performing the transfer at the level of the thumb metacarpal. Our purpose was to evaluate whether this modified transfer could restore both the extension and the radial abduction of the thumb without rerouting the EPL. Methods: We restored thumb function of 5 patients with unrecovered radial nerve palsy (4 men and 1 women; mean age at surgery, 47 years; mean duration between onset of palsy and surgery, 13 months; and mean follow-up period after surgery, 17 months). The PA was dissected in continuity with the PL (PA/PL) tendon, as is done in Camitz thumb opponensplasty. Another skin incision was made on the dorsal side of the thumb metacarpal, and the EPL tendon was exposed. The PA/PL tendon was drawn into this skin incision, passing under the abductor pollicis longus and extensor pollicis brevis tendons. The PA/PL tendon was woven into the undivided EPL tendon and immobilized for 3 weeks. Results: The mean values of active hyperextension and flexion of the interphalangeal joint, radial abduction, palmar abduction of the thumb, grip strength, and tip pinch strength of the involved/contralateral sides were 3°/7°, 41°/49°, 59°/65°, 65°/70°, 37 kg/47 kg, and 4.0 kg/5.2 kg, respectively. Discussion: We used the PA to lengthen the PL tendon, to transfer it to the EPL at a level distal to the Lister tubercle. Because our procedure is based on the concept of standard transfer, it should yield similar long-term results. Our procedure should be a good alternative, especially in cases of closed radial nerve injury, because it preserves the paralyzed EPL for possible future recovery. Type of study/level of evidence: Therapeutic IV.

KW - extensor pollicis longus

KW - palmar aponeurosis

KW - palmaris longus

KW - radial nerve palsy

KW - Tendon transfer

UR - http://www.scopus.com/inward/record.url?scp=84867859075&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84867859075&partnerID=8YFLogxK

U2 - 10.1016/j.jhsa.2012.08.017

DO - 10.1016/j.jhsa.2012.08.017

M3 - Article

C2 - 23101533

AN - SCOPUS:84867859075

VL - 37

SP - 2357

EP - 2361

JO - Journal of Hand Surgery

JF - Journal of Hand Surgery

SN - 0363-5023

IS - 11

ER -