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Restoration Of Pinch Strength Following Ulnar Nerve Palsy: Nerve Transfer Of Opponens Pollicis To The Terminal Division Of The Deep Branch Of The Ulnar Nerve
Charles Richard Arendale, IV, BS1, Madeline Rieker, MD
2, Julia Mastracci, MD
3, Bryan Loeffler, MD
3, Glenn Gaston, MD
3.
1Albany Medical College, Albany, NY, USA,
2Atrium Health Musculoskeletal Institute, Charlotte, NC, USA,
3OrthoCarolina Hand Center, Charlotte, NC, USA.
PURPOSE: Ulnar nerve injury can cause weak pinch strength through paralysis of the first dorsal interosseus (FDI) and adductor pollicis muscles. Current reconstructive strategies generally fail to reanimate these muscles. It has been suggested that nerve transfer of opponens pollicis to the terminal division of the deep branch of the ulnar nerve (Bertelli transfer) may restore pinch strength. The true effectiveness of this intervention remains unknown as the literature shows few cases from a single author.
METHODS: All Bertelli transfers at our institution with ≥1-year of follow-up were identified. Key and subterminal pinch, grasp, and pinch to zoom strength were assessed (kilograms). First web bulk (millimeters), Kapandji’s score, and patient-reported outcomes were collected. Operative hand strength was expressed as a percentage of that observed in the contralateral.
RESULTS: 11/11 patients demonstrated FDI reinnervation at a mean follow-up of 45.5 ± 15.6 months. Key pinch and subterminal pinch strength were 48.2% ± 17.9% and 44.1% ± 22.3%, respectively, of the contralateral hand. Grasp strength was 59.8% ± 35.5% of the uninjured side. Mean first web bulk was > 80% of that seen in the non-operative hand. At final follow-up, 36.4% of patients demonstrated a persistent ulnar claw with 81.8% showing a positive Froment sign.
CONCLUSIONS: Bertelli nerve transfer may reliably enable FDI reinnervation and generally restore approximately half the pinch strength observed in the uninjured hand.
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