Restoration of Pinch Grip in Ulnar Nerve Paralysis: Extensor Carpi Radialis Longus to Adductor Pollicis and Abductor Pollicis Longus to First Dorsal Interosseus Tendon Transfers

Abstract

A double tendon transfer was used to restore thumb pinch in nine consecutive patients. The extensor carpi radialis longus was transferred to the adductor pollicis tendon and one slip of the abductor pollicis longus was transferred to the first dorsal interosseus tendon. The patients were followed for 6 (range, 2–10) years and there were no instances of transfer rupture. Selective recruitment of the motors of the transfers was possible in all cases. Their amplitude was considered adequate for all the cases of adductor transfers but was limited in all of the first dorsal interosseus ones. Key pinch was 73% (range, 41–104%), the pulp-to-pulp pinch was 72% (range, 50–95%) and the power grip was 73% (range, 35–91%) of the opposite hand. The force of thumb adduction was 63% (range, 27–132%) and of index finger abduction was 58% (range, 21–104%) of the unaffected side.