Restoration of Pinch Strength After Traumatic Ulnar Nerve Injury: Outcomes of Transfer of the Opponens Pollicis Branch to the Terminal Division of the Deep Branch of the Ulnar Nerve

IF 2.4 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume Pub Date : 2026-09-01 Epub Date: 2026-05-26 DOI:10.1016/j.jhsa.2026.04.013

Madeline Rieker MD, Richard Arendale BS, Julia Mastracci MD, Ryan Serbin MD, Kayla Hietpas MPH, Bryan Loeffler MD, Glenn Gaston MD

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引用次数: 0

Abstract

Purpose

Ulnar nerve injury causes weak pinch strength through paralysis of the first dorsal interosseus and adductor pollicis muscles. Current reconstructive strategies provide variable reanimation of these muscles. It has been suggested that nerve transfer of the opponens pollicis (OPB) motor branch to the terminal division of the deep branch of the ulnar nerve (TDDBUN) may successfully restore pinch strength. The true effectiveness of this intervention remains unknown as there are few cases in the literature with all originating from a single author.

Methods

We retrospectively identified patients who underwent transfer of OPB to TDDBUN at a single institution between 2019 and 2025 with at least 1-year clinical follow-up. Patients were excluded if they were unavailable to return for in-office strength testing. Key and subterminal key pinch, pinch-to-zoom, and grip strength (kg) were measured using dynamometers and compared with the contralateral side. First web space bulk (mm), Kapandji score, Froment’s sign, and patient-reported outcomes (Disability of the Shoulder and Hand and Visual Analog Pain Scale) were assessed.

Results

Twelve patients underwent transfer of OPB to TDDBUN and were available for in-office strength testing at greater than 1 year follow-up. The median patient age was 42 years (range, 19–66 years). Mean key pinch and subterminal key pinch strength were 48% (SD 17) and 43% (SD 23) of the uninjured side, respectively. Average pinch-to-zoom strength was 58% (SD 31) of the uninjured side. Average grip strength was 56% (SD 36) of the uninjured side. Mean first web space bulk was 81% (SD 15) of the contralateral. Interestingly, at final follow-up, 10 of 12 patients retained a positive Froment sign, despite pinch strength recovery. All patients retained thumb opposition with a Kapandji score ≥5.

Conclusions

Transfer of OPB to TDDBUN may reliably reinnervate the first dorsal interosseous and adductor pollicis, restoring approximately half of the pinch strength observed in the uninjured hand.

Type of study/level of evidence

Therapeutic IV.

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外伤性尺神经损伤后捏力的恢复：掌对支转移至尺神经深支终支的效果。

目的：尺神经损伤通过第一背骨间肌和拇内收肌麻痹引起捏捏力弱。目前的重建策略提供了这些肌肉的可变恢复。有研究认为，将掌侧神经运动支（OPB）转移至尺神经深支终支（TDDBUN）可成功恢复捏压强度。这种干预的真正有效性仍然是未知的，因为文献中很少有病例都来自一个作者。方法：我们回顾性地确定了2019年至2025年间在单一机构接受OPB转移到TDDBUN的患者，并进行了至少1年的临床随访。如果患者无法返回办公室进行力量测试，则排除患者。使用测力计测量键和亚终端键捏、捏变焦和握力（kg），并与对侧进行比较。评估第一网络空间体积（mm）、Kapandji评分、Froment体征和患者报告的结果（肩手残疾和视觉模拟疼痛量表）。结果：12例患者将OPB转移到TDDBUN，随访超过1年，可进行办公室力量测试。患者年龄中位数为42岁（范围19-66岁）。未损伤侧的平均键夹和亚末端键夹强度分别为48% （SD 17）和43% （SD 23）。未损伤侧的平均捏变焦强度为58% （SD 31）。未受伤侧的平均握力为56% （SD 36）。平均首网空间体积为对侧的81% （SD 15）。有趣的是，在最后的随访中，12名患者中有10名保留了阳性的Froment征，尽管捏力恢复了。Kapandji评分≥5的患者均保留拇指反对。结论：将OPB转移到TDDBUN可以可靠地重建第一背骨间和拇内收肌，恢复未受伤手约一半的捏紧力。研究类型/证据水平：治疗性IV。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hand Surgery-American Volume 医学-外科

CiteScore

3.20

自引率

10.50%

发文量

402

审稿时长

12 weeks

期刊介绍： The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of Books and Media, and Letters to the Editor.