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Four cases treated with tendon transfer for pinch reconstruct were studied. Three patients with loss of both thumb adduction and index abduction by either ulnar nerve injury (2 cases) or brachial plexus injury (1 case) received simultaneous reconstruction of index abduction by transfer of abductor pollicis longus (APL) after Neviaser's method and thumb adduction by extensor indicis proprius transfer (EIP transfer). Average side pinch strength improved from 1.9kg to 3.1kg after surgery. One patient who could not pinch at all after adductor release for burn contractures only received EIP transfer. However, he became able to pinch small objects, even though his pinch strength was 0kg. EMG recordings from APL of healthy volunteers demonstrated little APL activity during side pinch movement. However, high APL activity was seen during side pinch in cases who had received a Neviaser transfer. Functional side pinch was regained in cases who received simultaneous tendon transfer to reconstruct both index abduction and thumb adduction. Transferred APL started to abduct the thumb independently.

Pinch Reconstruction by Tendon Transfer Using Abductor Pollicis Longus and Extensor Indicis Proprius.