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Extensor indicis proprius opponensplasty for isolated traumatic low median nerve palsy: A case series

Author(s): Mohammad M Al-Qattan

Introduction: The standard opponensplasty for isolated low median nerve palsy in nonleprosy patients uses the flexor digitorum superficialis of the ring finger.
Objective: To report the results of extensor indicis proprius (EIP) opponensplasty in 15 consecutive nonleprosy patients with isolated traumatic low median nerve palsy.
Methods: A retrospective study of the author’s cases of EIP opponensplasty for isolated traumatic median nerve palsy over the past 15 years was conducted. The author used the EIP to restore thumb opposition in all cases of isolated median nerve palsies when the following conditions were present: protective sensibility in the median nerve distribution; normal power of EIP; supple hands; and full passive range of opposition with no contracture of the first web space. There were a total of 15 patients with a mean age of 30 years (range 20 to 45 years). They all had traumatic isolated low median nerve palsy with recovery of at least protective sensation and no recovery of opposition. The tendon was harvested just proximal to the extensor expansion, the flexor carpi ulnaris was used as a pulley and the insertion was to the tendon of abductor pollicis brevis.
Results: There were no postoperative complications or extension lag of the donor finger. Using previously published criteria, 12 patients experienced excellent results while the remaining three had a good result.
Conclusions: In nonleprosy patients with isolated traumatic low median nerve palsy, the results of this transfer are consistent and there is no need to harvest the EIP tendon distal to the extensor expansion because a single insertion to the abductor pollicis brevis is sufficient.