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Modified Extensor Indicis Proprius Opponensplasty.

Nuttara Wiboonthanasarn1,2, Kanon Limudomporn1,3, Chairoj Uerpairojkit1

  • 1Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Pathum Thani.

Techniques in Hand & Upper Extremity Surgery
|March 25, 2024
PubMed
Summary

A modified extensor indicis proprius (EIP) opponensplasty effectively restores thumb function in patients with severe carpal tunnel syndrome. This technique improves thumb abduction and opposition, offering a safe and successful alternative.

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Area of Science:

  • Orthopedics
  • Hand Surgery
  • Reconstructive Surgery

Background:

  • Thenar muscle dysfunction, often due to median nerve palsy, impairs thumb abduction and opposition.
  • The standard extensor indicis proprius (EIP) opponensplasty has limitations, including a suboptimal tendon pull direction and potential need for extensor hood harvesting.
  • Restoring thumb function is crucial for hand dexterity and daily activities.

Purpose of the Study:

  • To present an alternative, modified technique for EIP opponensplasty.
  • To evaluate the clinical outcomes and efficacy of this modified EIP opponensplasty.

Main Methods:

  • A modified EIP opponensplasty was surgically performed on 16 patients diagnosed with severe carpal tunnel syndrome.
  • Clinical outcomes were assessed using the Kapandji score, thumb abduction angle measurements, and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.

Main Results:

  • All 16 patients achieved their desired functional activity levels post-surgery.
  • Significant improvements were observed in Kapandji scores, thumb abduction angles, and DASH scores across all participants.
  • No complications arose from harvesting the EIP tendon; two patients experienced transient finger stiffness, which resolved with rehabilitation.

Conclusions:

  • The modified EIP opponensplasty is a safe and effective surgical option for restoring thumb function in patients with median nerve palsy.
  • This technique addresses the limitations of the original EIP opponensplasty, particularly concerning tendon length, and yields positive functional outcomes.