Redirection of extensor pollicis longus in the treatment of spastic thumb-in-palm deformity

Twenty patients with the thumb-in-palm deformity associated with cerebral palsy were treated surgically by redirecting the extensor pollicis longus (EPL) tendon through the first dorsal retinacular compartment in association with releasing the spastic intrinsic thenar muscles at their origin. The redirected EPL tendon augmented extension-abduction of the thumb in all patients; 18 patients were able to grasp with the thumb outside the clenched fist and noted improvement in functional activities. Augmentation tendon transfer that uses the EPL is an ideal surgical treatment for patients with cerebral palsy who have a thumb-in-palm deformity, since the procedure relieves an adduction deforming force and augments the weak extension-abduction by means of a musculotendon transfer that is known to function during digital extension. Consequently, postoperative reeducation of the transfer is minimal.