Modified moberg opponensplasty in acquired spastic hemiplegia

Loss of the transverse arch of the hand and decreased thumb opposition has heretofore been an unreported deformity in the adult acquired spastic hemiplegic upper extremity. Based on Moberg's experience in quadriplegic patients, 11 patients underwent release of the annular ligament at the base of the thumb. This procedure allows the flexor pollicis longus tendon to bowstring and substitute for thumb opposition. All 11 had increased prehension capacity following the surgery. In carefully selected adult acquired spastic hemiplegic patients, release of the annular ligament at the base of the thumb can functionally restore the transverse arch of the hand, improve thumb opposition and improve prehensile capacity.