The opponens pollicis inserts along the entire radial shaft of the first metacarpal, producing the CMC pronation and palmarflexion that brings the thumb pad to face the finger pads. In median nerve palsy, the opponens is denervated along with the APB and superficial FPB, eliminating true CMC opposition. The various opposition restoration tendon transfers (Bunnell, Huber, Camitz, abductor digiti minimi) all aim to reproduce the line of pull of the opponens.
CMC joint rotation of the thumb (pronation and palmarflexion) — the key biomechanical element of thumb opposition
Opposition restoration surgery (opponensplasty) targets replacing opponens pollicis function in median nerve palsy and congenital hypoplastic thumb. The Camitz procedure uses palmaris longus lengthened with a palmar fascia strip routed to the APB. The Huber transfer uses abductor digiti minimi rotated 180 degrees on its neurovascular pedicle to the thenar eminence.
Opponens pollicis replacement surgery for median nerve palsy opposition loss using tendon transfer to restore CMC pronation and palmarflexion.
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