Restoration of Pinch and Opposition in Hand

A. Arthrodesis

  15 degrees IR , slightly flexed

   if no tendons for transfer , at 20 degrees flexion , IP joint for a IP joint flexion contracture .


B. Tendon transfers

 1 . Riorddan

   FDS RF through loop of FCU to thenar region to apponeurosis of EPL and Abductor Pollicis .


 Post - operatively - 3/52 dressing, then splint remove and active motion intermmitantly

     
 thumb splint in opposition for 6 weeks , teach opposition with RF.




2. Brand transfer

 FDS RF to thenar region  then split into two slips.

          1st  passed to ulnar side of thumb IP joint proximally

          2nd passed to Abductor Pollicis and EPL .


3. Bulkhalter

        EIP taken to subcutaneuos tissue and ulnar border of wrist to palm to thumb to MP capule


         thumb , Abductor Pollicis Brevis and EPL .



4. Grooves and Goldner

     FCU and Sublimus

      FCU - proximal portion alongwith sublimus passed and loop created by distal portion of FCU

       with ECU .


5. Camitz Technique

     PL to Abductor Pollicis Brevis

6. Muscles transfer , Littler and Cooley

 Abductor Digiti Minimi to resotre opposition

If no other muscles  , it also gives thenar atrophied muscles a bulk.









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