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Matsuura Y, Yamazaki T, Suzuki T, Akasaka T, Ohtori S. Opposition Transfer Using the Extensor Indicis Muscle and the Extensor Pollicis Brevis Tendon. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:383-389. [PMID: 38817755 PMCID: PMC11133921 DOI: 10.1016/j.jhsg.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/19/2024] [Indexed: 06/01/2024] Open
Abstract
Purpose This study aimed to introduce a novel technique using the extensor pollicis brevis and extensor indicis proprius tendons as power sources for thumb opposition reconstruction in cases of severe carpal tunnel syndrome (CTS) associated with thenar muscle atrophy. Furthermore, the efficacy of this novel method and the traditional Camitz technique was compared. Methods Patients with severe CTS and thumb opposition dysfunction who underwent surgery using the novel technique (n = 7 and 9 surgeries) or the Camitz technique (n = 8 and 8 surgeries) were included in the analysis. The pre- and postoperative palmar abduction angle, thumb-ring finger opposition angle, and Kapandji score were assessed. The repeated measures analysis of variance and the Mann-Whitney U test were used for statistical analysis. Results The novel technique was associated with a significant postoperative improvement in palmar abduction angle, thumb-ring finger opposition angle, and Kapandji score. In particular, the thumb-ring finger opposition angle of patients who underwent surgery using this technique was superior to that of patients who underwent surgery using the Camitz technique. Therefore, the novel technique was highly effective in improving thumb pronation. Conclusion The novel technique using the extensor pollicis brevis and extensor indicis proprius tendons is promising for thumb opposition reconstruction in severe CTS cases. Unlike the traditional Camitz technique, this approach promotes stable thumb opposition function without requiring a pulley, thereby yielding satisfactory outcomes. Nevertheless, further studies with a larger sample size should be conducted to validate these findings. Type of study/level of evidence Therapeutic 4; Surgical technique.
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Affiliation(s)
- Yusuke Matsuura
- Department of Orthopaedic Surgery, Graduate School of medicine, Chiba University, Chiba, Japan
| | - Takahiro Yamazaki
- Department of Orthopaedic Surgery, Graduate School of medicine, Chiba University, Chiba, Japan
| | - Takane Suzuki
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoyo Akasaka
- Department of Rehabilitation Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of medicine, Chiba University, Chiba, Japan
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Takashima K, Iba K, Emori M, Teramoto A, Aoki M. Thumb pronation efficacy of Camitz tendon transfer with insertion on the ulnar capsule of the metacarpophalangeal joint: a cadaver study. J Hand Surg Eur Vol 2023:17531934231214430. [PMID: 37987691 DOI: 10.1177/17531934231214430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Several studies have indicated that Camitz transfer for severe carpal tunnel does not adequately restore thumb opposition. The aim of this study was to determine whether modification of the distal insertion of the transferred palmaris longus tendon could provide more effective opposition. We used 12 fresh-frozen upper extremity specimens. For spatial analysis, we used a three-dimensional motion-tracking device. At 0 N and 5 N of traction force, the pronation angle was significantly larger for the modified procedure than for the conventional procedure. There was no significant difference in the palmar abduction angle between the two groups. The modified palmaris longus tendon insertion on the ulnar side of the thumb metacarpophalangeal joint provides more effective thumb pronation than conventional Camitz opponensplasty in a cadaver model. .
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Affiliation(s)
- Kenichi Takashima
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
- Department of Musculoskeletal Anti-aging Medicine, Sapporo Medical University, Sapporo, Japan
| | - Kousuke Iba
- Department of Musculoskeletal Anti-aging Medicine, Sapporo Medical University, Sapporo, Japan
| | - Makoto Emori
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Mitsuhiro Aoki
- Department of Physical Therapy, Graduate School of Rehabilitation Science, Health Sciences University of Hokkaido, Sapporo, Japan
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Jerome JTJ. Wide-awake local anesthesia no tourniquet and dexamethasone (WALANT-D) for modified Camitz opponens plasty in severe carpal tunnel syndrome-a retrospective study of 30 cases. J Clin Orthop Trauma 2023; 43:102228. [PMID: 37547272 PMCID: PMC10403721 DOI: 10.1016/j.jcot.2023.102228] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/24/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023] Open
Abstract
Background To analyze the outcome of modified Camitz opponens plasty using the wide-awake local anesthesia no tourniquet with dexamethasone (WALANT-D) technique in severe carpal tunnel syndrome (CTS). Methods A retrospective review was performed in 30 hands of 27 patients who underwent Camitz opponens plasty for severe CTS between 2019 and 2021. All patients had 8 mg of dexamethasone mixed with WALANT. Preoperative active palmar abduction, grip strength, side, and pulp pinch strength, Kapandji score, and electrophysiological assessment of compound muscle action potential (CMAP) for abductor pollicis brevis (APB) were compared with the postoperative values. The palmaris longus had dual insertion into the abductor pollicis brevis and extensor expansion. The time interval of post-operative pain-free was noted. The Disabilities of the Arm, Shoulder, and Hand (DASH) and Carpal Tunnel Syndrome instrument (CTSI) also assessed the functional outcome. Results The mean age of patients was 35 years (range 32-58 years). There were five male and 22 female patients. Of the female patients, three females had severe bilateral CTS. Twenty right and ten left hands were affected. The mean follow-up of our study was 12.5 months (range 10-14 months). The patients were pain-free for an average of 19.5 h postoperatively. There was a significant improvement in the thumb palmar abduction, grip strength, side, and pulp pinch strength, DASH score, CTSI, and APB-CMAP (p < 0.05) at the final follow-up. Conclusions Modified Camitz opponens plasty with a dual insertion into APB and extensor expansion effectively improves thumb opposition and daily activities. The tendon tensioning, checking the pulley impingement, appreciation of active movements, and a comfortable patient operative experience are advantages of the WALANT. Adding dexamethasone as an adjuvant to WALANT prolongs the analgesia and duration of the nerve block. Level of evidence IV, Retrospective case study.
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Affiliation(s)
- J. Terrence Jose Jerome
- European Diploma Hand Surgery, FICS, Department of Orthopedics, Hand, and Reconstructive Microsurgery, Olympia Hospital & Research Centre, 47, 47A Puthur High Road, Puthur, Trichy, Tamilnadu, 620017, India.
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Cinclair T, Urquia L, Hembd A, Lies S. Pedicled Pronator Quadratus Transposition for Functional Opponensplasty: A Cadaveric Anatomical Study for Feasibility. Hand (N Y) 2023:15589447231153177. [PMID: 36788761 DOI: 10.1177/15589447231153177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Techniques on opponensplasty for chronic carpal tunnel syndrome have been described previously. A novel pronator quadratus (PQ) transposition for chronic carpal tunnel syndrome is described. In addition, the relationship of the distal perforating branch of the radial artery to the surrounding tissue is detailed to optimize further use of the PQ flap for clinical applications. METHODS Ten cadaver hands underwent PQ dissection, and the perforating branch of the radial artery was identified. Measurements were taken from the radiocarpal joint and the radial styloid to the distal perforating branch. Finally, a proposed surgical technique of PQ transposition with proximal radius periosteum to the first metacarpophalangeal joint and anterior interosseous nerve transfer was performed. RESULTS The average distance of the perforating branch from the radiocarpal joint was 10 ± 1.05 mm, and the average distance from the radial styloid was 17.1 ± 1.6 mm. Pronator quadratus transposed with a layer of radius periosteum demonstrated anatomical feasibility. CONCLUSIONS The distal perforating branch of the radial artery predictably perfuses the PQ muscle, which may be used in the future as a means of opponensplasty for chronic carpal tunnel syndrome.
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Affiliation(s)
- Trey Cinclair
- The University of Texas Southwestern Medical Center, Dallas, USA
| | - Lindsey Urquia
- The University of Texas Southwestern Medical Center, Dallas, USA
| | - Austin Hembd
- The University of Texas Southwestern Medical Center, Dallas, USA
| | - Shelby Lies
- The University of Texas Southwestern Medical Center, Dallas, USA
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Perruisseau-Carrier A, Artz M, Ta P, Seizeur R, Hu W, Le Nen D. Feasibility of the abductor pollicis longus hemitendon transfer for thumb opposition: An anatomical study. Orthop Traumatol Surg Res 2023; 109:103548. [PMID: 36638865 DOI: 10.1016/j.otsr.2023.103548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/06/2022] [Accepted: 12/07/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The abductor pollicis longus (APL) presents two muscle bellies and multiple accessory tendons available for transfer, amongst these an accessory tendon inserting on the thenar aponeurosis (APLTh). Edgerton described an opponensplasty using the whole APL tendon, but its results were limited due to the short size of the donor tendon. HYPOTHESIS The purpose of this study is to assess the feasibility of transferring the APLTh for thumb opposition. MATERIAL AND METHODS Eleven cadaver upper limbs were dissected to assess the presence of the two heads of the APL as well as their main and accessory tendon insertions. The accessory tendon of the APL inserting on the thenar aponeurosis (APLTh) was harvested with a slip of the thenar aponeurosis. The length of the transplant, the number of tendon slips and their location, as well as pre and postoperative radial and palmar abduction provided by the APL were assessed. RESULTS The APL was present in all cadavers whereas its insertion on the thenar aponeurosis was absent in 18% of the cases. When the APLTh was present and could be used for opponensplasty, the mean gain in palmar abduction was 16 degrees, and the mean loss in radial abduction was 21 degrees. DISCUSSION Although the experiments revealed a variability in APL anatomy, when present, the APLTh represents a suitable donor for the restoration of thumb opposition. In some cases of high median nerve palsies, thumb opposition can't be restored using median innervated muscles. In these cases, when the APLTh is present, it can be used to restore thumb opposition without functional loss. LEVEL OF EVIDENCE IV; anatomical feasibility study.
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Affiliation(s)
- Anne Perruisseau-Carrier
- Département de chirurgie plastique, reconstructrice et esthétique, SOS Main, CHRU de Brest, Brest, France; Université de Bretagne Occidentale, Brest, France.
| | - Manon Artz
- Département de chirurgie plastique, reconstructrice et esthétique, SOS Main, CHRU de Brest, Brest, France
| | - Pierre Ta
- Département de chirurgie plastique, reconstructrice et esthétique, SOS Main, CHRU de Brest, Brest, France; Université de Bretagne Occidentale, Brest, France
| | | | - Weiguo Hu
- Département de chirurgie plastique, reconstructrice et esthétique, SOS Main, CHRU de Brest, Brest, France; Université de Bretagne Occidentale, Brest, France
| | - Dominique Le Nen
- Université de Bretagne Occidentale, Brest, France; Département de chirurgie orthopédique et traumatologique, SOS Main, CHRU de Brest, Brest, France
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Matsuki H, Nakatsuchi Y, Momose T. Opponensplasty using the extensor indicis proprius tendon for severe carpal tunnel syndrome in 40 patients. J Hand Surg Eur Vol 2022; 47:353-358. [PMID: 34670436 DOI: 10.1177/17531934211045957] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to assess the clinical results after extensor indicis proprius opponensplasty in patients with carpal tunnel syndrome and severe thenar muscle atrophy. Forty patients who underwent this procedure during open carpal tunnel releases. The mean follow-up period was 17 months (range 10 to 36). Kapandji scores significantly improved from 5.5 before surgery to 9.6 at final follow-up. Thumb pronation angle also significantly improved from 111° before surgery to 149°. Side and pulp pinch strength significantly improved postoperatively, as well as DASH scores at final follow-up. In conclusion, the extensor indicis proprius tendon transfer technique represents a reliable opponensplasty procedure to achieve consistent results in patients with severe carpal tunnel syndrome.Level of evidence: IV.
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Affiliation(s)
- Hiroyuki Matsuki
- Department of Orthopaedic Surgery, Marunouchi Hospital, Matsumoto, Nagano, Japan
| | - Yukio Nakatsuchi
- Department of Orthopaedic Surgery, Marunouchi Hospital, Matsumoto, Nagano, Japan
| | - Toshimitsu Momose
- Department of Orthopaedic Surgery, Marunouchi Hospital, Matsumoto, Nagano, Japan
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Hirakawa A, Komura S, Nohara M, Masuda T, Matsushita Y, Akiyama H. Opponensplasty by the Palmaris Longus Tendon to the Rerouted Extensor Pollicis Brevis Transfer With Endoscopic Carpal Tunnel Release in Severe Carpal Tunnel Syndrome. J Hand Surg Am 2021; 46:1033.e1-1033.e7. [PMID: 34034945 DOI: 10.1016/j.jhsa.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 01/30/2021] [Accepted: 04/05/2021] [Indexed: 02/02/2023]
Abstract
In patients with severe carpal tunnel syndrome (CTS), restoring thumb opposition is critical because this function is essential for proper pinching, grasping, and other complex hand movements. Opponensplasty is an effective procedure to preserve thumb function, with several methods reported. Camitz opponensplasty, using the palmaris longus (PL), is an option for patients with severe CTS. Recently, several modified Camitz procedures have been proposed to overcome the shortcomings of the original description. This article describes the surgical technique of the opponensplasty using the PL tendon to the rerouted extensor pollicis brevis transfer. The procedure provides satisfactory outcomes for early functional recovery of the hand in patients with severe CTS.
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Affiliation(s)
- Akihiro Hirakawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan.
| | - Shingo Komura
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Marie Nohara
- Division of Rehabilitation, Gifu University Hospital, Gifu, Japan
| | - Tomihiro Masuda
- Division of Rehabilitation, Gifu University Hospital, Gifu, Japan
| | | | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
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8
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Tomori Y, Nanno M, Kentaro S, Majima T. Novel Surgical Procedure for Half Palmaris Longus Transfer during Opponensplasty of the Thumb for Patients with Carpal Tunnel Syndrome: A Technical Note. J NIPPON MED SCH 2021; 88:149-153. [PMID: 32741902 DOI: 10.1272/jnms.jnms.2020_88-206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Thumb opposition is an essential movement for daily use of the hand, including precise pinching/grasping and fine and complicated hand movement. Although studies have reported use of several donor tendons for opponensplasty, opponensplasty using the palmaris longus (i.e., Camitz opponensplasty) has been used in patients with loss of opposition function due to longstanding carpal tunnel syndrome. The procedure involves a simple, useful tendon transfer and does not cause functional deficits. To obtain enough length to transfer the tendon to the metacarpophalangeal joint of the thumb, the PL tendon should be obtained with the palmar aponeurosis. However, the palmar aponeurosis is not always available for opponensplasty, as it is occasionally thin and insufficient for elongation of the palmaris longus. An extended skin incision over the palm can cause painful scar formation and postoperative residual pain. This procedure restores the palmar abduction function of the thumb but not opposition function. In the present article, we describe a modification of Camitz opponensplasty that uses a half-split palmaris longus, which is long enough to anchor to the insertion of the adductor pollicis at the metacarpophalangeal joint of the thumb.
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Affiliation(s)
- Yuji Tomori
- Department of Orthopedic Surgery, Nippon Medical School Hospital
| | - Mitsuhiko Nanno
- Department of Orthopedic Surgery, Nippon Medical School Hospital
| | - Sonoki Kentaro
- Department of Orthopedic Surgery, Nippon Medical School Hospital
| | - Tokifumi Majima
- Department of Orthopedic Surgery, Nippon Medical School Hospital
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9
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Kuroiwa T, Koyama T, Fujita K. Coordination of Thumb Pronation and Palmar Abduction During Opposition Movement. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:160. [PMID: 35415546 PMCID: PMC8991545 DOI: 10.1016/j.jhsg.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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10
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Iwase M, Matsuura Y, Kuniyoshi K, Suzuki T, Nagashima K, Ohtori S. Biomechanical Evaluation of Opponensplasty for Low Median Palsy: A Cadaver Study. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:74-80. [PMID: 35415542 PMCID: PMC8991460 DOI: 10.1016/j.jhsg.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/25/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose Impaired thumb opposition associated with advanced carpal tunnel syndrome may be treated by opponensplasty at the time of open carpal tunnel release. However, it is unclear which opponensplasty technique achieves the greatest functional improvement. This study aimed to compare the biomechanics of thumb opposition after Camitz, modified Camitz, and Burkhalter opponensplasties. Methods We used 6 fresh-frozen cadaveric arms. Each procedure was reproduced on each arm: Camitz opponensplasty, modified Camitz opponensplasty involving palmaris longus transfer routed around the flexor carpi ulnaris pulley, and Burkhalter opponensplasty. Arms were fixed with the wrist in 0° flexion and the forearm in neutral pronosupination, and sensors were placed on the thumbnail, radial styloid, and dorsal aspect of the second metacarpal head. The donor tendon was pulled using a mechanical testing machine with a maximum force of 25 N, and the locations of the sensors in thumb opposition were recorded. The first web space and thumb pronation angles were measured for each procedure and compared. Results The mean first web space and pronation angles produced using 25 N were 55° and 20°, 57° and 26°, and 53° and 29° for the Camitz, modified Camitz, and Burkhalter opponensplasties, respectively. The first web space angle was significantly larger after modified Camitz opponensplasty compared with Burkhalter opponensplasty with 25 N loading. Camitz opponensplasty resulted in a significantly smaller pronation angle compared with modified Camitz and Burkhalter opponensplasties with 25 N loading. Conclusions The modified Camitz opponensplasty produces a relatively balanced biomechanical outcome in terms of the first web space and pronation angles. Conversely, Burkhalter opponensplasty has been shown to be a favorable technique for improving pronation. Clinical relevance Modified Camitz opponensplasty with a pulley offers effective restoration of thumb opposition, including pronation. On the other hand, Burkhalter opponensplasty represents a suitable option not only for patients with high median palsy and injury to the palmar aponeurosis but also for those who require improved pronation.
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Affiliation(s)
- Maki Iwase
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
| | - Yusuke Matsuura
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
- Corresponding author: Yusuke Matsuura, MD, PhD, Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohaana, Chuo-ku, Chiba City, Chiba 260-8670, Japan.
| | - Kazuki Kuniyoshi
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
| | - Takane Suzuki
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kengo Nagashima
- Department of Global Clinical Research, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Chiba University, Chiba, Japan
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Moore CW, Fanous J, Rice CL. Fiber type composition of contiguous palmaris longus and abductor pollicis brevis muscles: Morphological evidence of a functional synergy. J Anat 2021; 238:53-62. [PMID: 32790091 PMCID: PMC7754940 DOI: 10.1111/joa.13289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/25/2020] [Accepted: 07/09/2020] [Indexed: 01/03/2023] Open
Abstract
The palmaris longus (PL) tendon is used in surgical opponensplasty to restore functional hand movements in thenar paralysis. Although successful PL autologous tendon transfer has been attributed to an established synergistic relationship between the PL and abductor pollicis brevis (APB) muscles in vivo, this functional relationship may be dependent on the quality of their spatial relationship and properties of their constituent muscle fibers. The purpose was to compare the proportion of type I and type II muscle fibers in the APB based on its contiguous morphological relationship with the PL tendon for indirect insight into their functional synergy, contractile capacity, and digastric arrangement. Twenty-four contiguous PL and APB specimens were harvested from the upper limbs (12 right and 12 left) of twelve formalin-embalmed cadavers (mean age: 74 ± 10 years). The fiber type composition of these muscles was determined by labeling serial cross sections with myosin heavy chain (MyHC) type I and type II monoclonal antibodies. The PL consisted of a relatively heterogeneous fiber type composition irrespective of the presence of a discrete (type I: 41 ± 11%; type II: 55 ± 12%; hybrid: 4 ± 3%) or rudimentary (type I: 49 ± 10%; type II: 45 ± 9%; hybrid: 6 ± 4%) tendinous connection with the APB. The APB fascicles arranged contiguously with the PL through a discrete tendon had significantly greater proportions of type II fibers (41 ± 19%) compared to those with rudimentary PL connections (type II: 15 ± 8%). Therefore, the APB fascicles arranged in a digastric relationship with the PL may have the capacity to produce more powerful contractions than those with rudimentary PL tendons based on the known contractile properties of type II muscle fibers. Knowledge of the spatial relationship between the PL and thenar musculature prior to PL autologous tendon transfer may be a useful indicator of the quality of established synergy in vivo.
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Affiliation(s)
- Colin W. Moore
- Department of Pathology & Anatomical SciencesJacobs School of MedicineUniversity at BuffaloBuffaloNYUSA
| | - Jacob Fanous
- School of Kinesiology, Faculty of Health SciencesThe University of Western OntarioLondonONCanada
| | - Charles L. Rice
- School of Kinesiology, Faculty of Health SciencesThe University of Western OntarioLondonONCanada,Department of Anatomy & Cell BiologySchulich School of Medicine & DentistryThe University of Western OntarioLondonONCanada
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Dehghani M, Fadaei B, Rastegar S, Zarezadeh A, Ghadimi K, Nikkhah R, Eslami S. Modified Camitz versus BRAND Procedures for the Treatment of Severe Carpal Tunnel Syndrome: A Comparative Trial Study. THE ARCHIVES OF BONE AND JOINT SURGERY 2020; 8:420-425. [PMID: 32766402 DOI: 10.22038/abjs.2019.14127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Carpal tunnel syndrome (CTS) is characterized by complications such as pain, paresthesia, and numbness in the fingers. There are some surgical therapies for the management of severe carpal tunnel, but differences exist between the treatments available for creating the opposition. The current study was conducted to compare the effect of modified Camitz and BRAND techniques on thumb opposition in patients with severe CTS. Methods A total of 40 patients with severe CTS who were candidates for opponensplasty were enrolled in this clinical trial study at Alzahra and Kashani hospitals, Isfahan, Iran, from 2014 to 2018. The patients were divided into two groups of modified Camitz and BRAND. Quick DASH-9 and Kapandji scores as well as pulp and side pinch and pronation angle were assessed before and after the surgeries. Results Quick DASH-9 score, Kapandji score, pulp and side pinch and pronation angle significantly improved post-operatively (P=0.0XXX, P=0.0XXX, P=0.0XXX, P=0.0XXX, and P=0.0XXX, respectively). But, no significant differences were seen in the mentioned variables between both groups pre and post-operative (P>0.05, for all the studied variables). No postsurgical complications were seen in any of the groups. Conclusion The findings of the present study demonstrated that, both Modified Camitz and BRAND techniques are effective and safe techniques, yielding high improvements, but no serious complications. Both techniques can be considered for treatment of patients with severe CTS.
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Affiliation(s)
- Mohammad Dehghani
- Department of Orthopedic, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrooz Fadaei
- Department of Orthopedic, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shirvan Rastegar
- Department of Orthopedic, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abolghasem Zarezadeh
- Department of Orthopedic, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Keyvan Ghadimi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roham Nikkhah
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sepehr Eslami
- Department of Orthopedic, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Jing SS, Jester A. Myth in hand surgery: When is an opponensplasty an abductorplasty? JPRAS Open 2020; 24:40-42. [PMID: 32337331 PMCID: PMC7177157 DOI: 10.1016/j.jpra.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/27/2020] [Indexed: 11/03/2022] Open
Affiliation(s)
- S S Jing
- Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom
| | - A Jester
- Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom
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Nanno M, Kodera N, Tomori Y, Takai S. Minimally invasive modified Camitz opponensplasty for severe carpal tunnel syndrome. J Orthop Surg (Hong Kong) 2019; 26:2309499018770914. [PMID: 29716413 DOI: 10.1177/2309499018770914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE We aimed to compare the clinical results and the complications between the minimally invasive modified Camitz opponensplasty and the conventional Camitz opponensplasty for severe carpal tunnel syndrome (CTS), and to evaluate the efficacy of the modified technique for CTS. METHODS Twenty-eight hands in 24 patients with severe CTS who had disorder of the thumb opposition with thenar muscle atrophy (group 1) were treated by minimally invasive modified Camitz opponensplasty, passing the transferred palmaris longus (PL) tendon under the abductor pollicis brevis (APB) fascia using only palm and thumb incision, and no incision to either wrist crease or forearm. Ten hands in 10 patients (group 2) were treated by the conventional Camitz opponensplasty. Clinical evaluation was made by comparing the results before and after surgery for the angle of the thumb palmar abduction, pinch power, and grip strength. RESULTS All clinical findings significantly improved after surgery compared with before surgery in all patients. In group 1, there were no complications including transferred tendon bowstring, painful wrist scar, or injury to the palmar cutaneous branch of the median nerve in all hands. Conversely, patients in group 2 had four painful wrist scars and nine bowstrings of the transferred tendon. CONCLUSIONS Several complications have been considered to attribute to the long incision and an extensive dissection crossing the wrist crease from the palm to the wrist in the conventional Camitz procedure. The current modified Camitz opponensplasty by minimally invasive incision without straddling the wrist crease is a simple and effective procedure that can decrease the risk of painful scar around the wrist crease in severe CTS patients with disorder of thumb opposition. Additionally, this technique, by passing the transferred PL tendon under the APB fascia, is useful in restoring the thumb opposition immediately, and in preventing the bowstringing of the transferred tendon.
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Affiliation(s)
- Mitsuhiko Nanno
- 1 Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
| | - Norie Kodera
- 1 Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
| | - Yuji Tomori
- 1 Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
| | - Shinro Takai
- 1 Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
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Garg B, Manhas V, Vardhan A, Srivastava DN, Das CJ, Vibha D, Gupta V, Malhotra R, Kotwal P. Thumb Opposition Recovery Following Surgery for Severe Carpal Tunnel Syndrome: A Clinical, Radiological, and Electrophysiological Pilot Study. J Hand Surg Am 2019; 44:157.e1-157.e5. [PMID: 29934085 DOI: 10.1016/j.jhsa.2018.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 03/31/2018] [Accepted: 05/01/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To objectively assess recovery of thumb opposition in patients with carpal tunnel syndrome (CTS) after open carpal tunnel release and to evaluate electrophysiological and magnetic resonance (MR) neurography findings as predictors of thumb opposition recovery. METHODS A total of 22 patients with severe CTS and thenar atrophy were included in this study. A detailed clinical, electrophysiological, and MR neurography evaluation was done both before and after surgery at 6 months to assess thumb opposition recovery. RESULTS The median duration of symptoms was 12 months (interquartile range, 12-20 months). The compound muscle action potential of the abductor pollisis brevis (CMAP-APB) also showed statistically significant improvement of 0.5 + 0.2 mV after surgery. Tip-tip pulp pinch strength increased from 1.2 ± 0.4 to 2.0 ± 0.4 kg at 6-month follow-up, lateral pulp pinch strength increased from 1.9 ± 0.6 to 2.8 ± 0.9 kg at 6-month follow-up, and 3-point pulp pinch also improved from 1.9 ± 0.5 to 2.8 ± 0.9 at final follow-up. On MR neurogram, the proportion of patients with abnormal median nerve morphology decreased from 81.8% to 68.2%, abnormal thenar branch morphology decreased from 63.6% to 36.4% and denervation edema deceased from 59.1% to 13.6%. CONCLUSIONS Patients suffering from severe CTS with thenar atrophy and detectable CMAP-APB showed promising improvement following open carpal tunnel release. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Vikrant Manhas
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
| | - Anand Vardhan
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Chandan J Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Gupta
- Department of Community Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Prakash Kotwal
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Kuroiwa T, Fujita K, Nimura A, Miyamoto T, Sasaki T, Okawa A. A new method of measuring the thumb pronation and palmar abduction angles during opposition movement using a three-axis gyroscope. J Orthop Surg Res 2018; 13:288. [PMID: 30445972 PMCID: PMC6240257 DOI: 10.1186/s13018-018-0999-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/06/2018] [Indexed: 11/25/2022] Open
Abstract
Background Thumb opposition is vital for hand function and involves pronation and palmar abduction. The improvement of pronation is often used as one of the evaluation items of the opponensplasty method for severe carpal tunnel syndrome. However, most of the studies used substitution evaluation methods for measurement of the pronation angle. Thus, there is still no appropriate method for measuring thumb pronation angle accurately in carpal tunnel syndrome patients. In recent reports, a wearable gyroscope was used to evaluate upper extremity motions and it can be possibly used for accurate measurement of the thumb pronation angle along the three-dimensionally moving bone axis. Thus, we investigated the reliability of measuring thumb pronation using a gyroscope and evaluated whether this method can be used to detect opposition impairment. Methods The participants were volunteers with unaffected upper limbs (32 hands) and patients with carpal tunnel syndrome (27 hands). The pronation and palmar abduction angles during opposition movements were measured using a three-axis gyroscope that included a three-axis accelerometer. The gyroscope was fixed onto the first metacarpal bone and the thumb phalanx. Results The pronation and palmar abduction angles of the metacarpal bone and the palmar abduction angles of the phalanx significantly decreased in the carpal tunnel syndrome group. The pronation angle of the metacarpal bone during opposition movement peaked later than the palmar abduction angle in all hands. Conclusions We were able to measure the thumb pronation and palmar abduction angles using the three-axis gyroscope, and this tool was able to detect impairments of thumb opposition due to carpal tunnel syndrome. This could be a tool for measuring thumb and finger angles and for detecting impairments caused by various diseases.
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Affiliation(s)
- Tomoyuki Kuroiwa
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-4-5, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Koji Fujita
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-4-5, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-4-5, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takashi Miyamoto
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-4-5, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Toru Sasaki
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-4-5, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Atsushi Okawa
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-4-5, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Poy-Gual C, Puente-Alonso C, Cano-Rodriguez G. Modified Camitz opponensplasty for treatment of severe carpal tunnel syndrome. J Hand Surg Eur Vol 2018; 43:889-891. [PMID: 30025484 DOI: 10.1177/1753193418787666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Corona Poy-Gual
- 1 Traumatology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona
| | - Carles Puente-Alonso
- 1 Traumatology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona.,2 Microsurgery and Hand Unit, Hospital de Sabadell, Sabadell, Barcelona
| | - Gisele Cano-Rodriguez
- 1 Traumatology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona
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Moore CW, Fanous J, Rice CL. Revisiting the functional anatomy of the palmaris longus as a thenar synergist. Clin Anat 2017; 31:760-770. [DOI: 10.1002/ca.23023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Colin W. Moore
- School of Kinesiology, Faculty of Health Sciences; The University of Western Ontario; London ON Canada
| | - Jacob Fanous
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry; The University of Western Ontario; London ON Canada
| | - Charles L. Rice
- School of Kinesiology, Faculty of Health Sciences; The University of Western Ontario; London ON Canada
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry; The University of Western Ontario; London ON Canada
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Minimally Invasive Palmaris Longus Abductorplasty for Severe Carpal Tunnel Syndrome. Tech Hand Up Extrem Surg 2017; 21:149-154. [PMID: 28914668 DOI: 10.1097/bth.0000000000000176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Camitz abductorplasty is the most commonly used tendon transfer in patients with severe carpal tunnel syndrome with significant muscle wasting and loss of opposition. This procedure requires a long incision in the palm to harvest a strip of palmar aponeurosis to lengthen the palmaris longus tendon, allowing it to reach the abductor pollicis brevis insertion. Several complications have been attributed to this extensive dissection in the palm. We describe a minimally invasive palmaris longus abductorplasty using a strip of free flexor carpi radialis tendon graft to achieve the necessary length. This can be done together with carpal tunnel release in patients with severe carpal tunnel syndrome.
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Abstract
Opposition is the placement of the thumb opposite the fingers into a position from which it can work. This motion requires thumb palmar abduction, flexion, and pronation, which are provided by the abductor pollicis brevis, flexor pollicis brevis (FPB), and opponens pollicis. In the setting of a median nerve palsy, this function is typically lost, although anatomic variations and the dual innervation of the FPB may prevent complete loss at times. There are multiple well described and accepted tendon transfers to restore opposition, none of which have been proven to be superior to the others.
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Affiliation(s)
| | - R Glenn Gaston
- OrthoCarolina, 1915 Randolph Road, Charlotte, NC 28211, USA.
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21
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Rymer B, Thomas PBM. The Camitz transfer and its modifications: a review. J Hand Surg Eur Vol 2016; 41:632-7. [PMID: 26768219 DOI: 10.1177/1753193415625605] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 12/10/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED The Camitz procedure involves transfer of the insertion of the palmaris longus tendon with a strip of the palmar aponeurosis to the insertion of abductor pollicis brevis in order to improve thumb opposition, and is usually done when severe carpal tunnel syndrome results in complete wasting of the thenar muscles. We carried out a systematic review of the published reports of this procedure. Analysis of available outcome data showed improvement in overall hand function in 86-100% of patients undergoing the original Camitz procedure. Several modifications of the original Camitz transfer have been described, with most focusing on the incorporation and placement of pulleys. All studies are limited by their small sample sizes. Overall, there is a lack of studies comparing the Camitz transfer with other opponensplasty techniques and comparing the various modifications of the original procedure. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- B Rymer
- Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent, Staffordshire, UK
| | - P B M Thomas
- Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent, Staffordshire, UK
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Kamiya H, Kimura M, Hoshino S, Kobayashi M, Sonoo M. Prognosis of severe carpal tunnel syndrome with absent compound muscle action potential. Muscle Nerve 2016; 54:427-31. [PMID: 26661833 DOI: 10.1002/mus.25004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Opponensplasty is a surgical option for patients with severe carpal tunnel syndrome (CTS). We investigated prognostic factors of patients who lack a preoperative compound muscle action potential (CMAP) of the abductor pollicis brevis (APB) muscle to determine the necessity for single-stage opponensplasty. METHODS We retrospectively enrolled 22 hands of 22 CTS patients. Prognostic factors considered were age, diabetes mellitus, the median sensory nerve action potential, distal motor latency of the second lumbrical (2L) CMAP (2L-DML), and its amplitude (2L-Amp). Postoperative APB-CMAP amplitude (post APB-Amp) at 12 months was used as the outcome measure. RESULTS Only 2L-DML showed a significant correlation with post APB-Amp (r = -0.56). The contribution of 2L-Amp was not significant, although 3 hands with absent 2L-CMAP had a poor electrophysiological recovery. CONCLUSIONS Prolonged 2L-DML and absent 2L-CMAP seem to be poor prognostic factors. Concurrent opponensplasty may not be necessary in patients with 2L-DML of 8 ms or less. Muscle Nerve 54: 427-431, 2016.
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Affiliation(s)
- Hisao Kamiya
- Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan
| | - Michio Kimura
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Satoshi Hoshino
- Central Laboratory, Teikyo University School of Medicine, Tokyo, Japan
| | | | - Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan
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Camitz tendon transfer using flexor retinaculum as a pulley in advanced carpal tunnel syndrome. J Hand Surg Am 2014; 39:2454-9. [PMID: 25300991 DOI: 10.1016/j.jhsa.2014.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 09/01/2014] [Accepted: 09/02/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To report the outcomes of modified Camitz abductor plasty using the released flexor retinaculum as a pulley in patients with advanced carpal tunnel syndrome. METHODS A retrospective review of 46 hands in 43 patients who underwent modified Camitz abductor plasty was performed. Active palmar abduction of thumb and pulp pinch strength were assessed. Patient-reported outcome measures were assessed using the Disabilities of the Arm, Shoulder, and Hand and Carpal Tunnel Syndrome instrument. As an electrophysiological assessment, compound muscle action potential (CMAP) from abductor pollicis brevis (APB) was investigated. RESULTS At 3 months, active palmar abduction of thumb and pulp pinch strength significantly improved. Although pulp pinch strength further improved, active abduction of thumb did not improve at the final follow-up. Both the patient-reported outcome measures improved at 3 months and further improved at final follow-up. Approximately 75% of improved scores were obtained at the first 3 months after surgery and the balance of improved scores (25%) was obtained by the time of final follow-up. Useful recovery of postoperative APB-CMAP (amplitude > 1.8 mV) was obtained in 3 hands (7%) at 3 months after surgery and in 23 hands (50%) at final follow-up. There was no statistical significance of the postoperative results including active palmar abduction of thumb and improvement of patient-reported outcome measures at final follow-up between the hands with useful recovery of postoperative APB-CMAP and the hands without it. CONCLUSIONS Modified Camitz abductor plasty benefitted the early improvement of activity of daily living in patients with advanced carpal tunnel syndrome. It acted not only as an internal orthosis in patients who eventually recovered thenar muscle function but also as the sole palmar abductor of the thumb in patients who failed to recover useful thenar muscle function. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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