Efficacy of Median Nerve Recurrent Branch Neurectomy as an Adjunct to Ulnar Motor Nerve Neurectomy and Wrist Arthrodesis at the Time of Superficialis to Profundus Transfer in Prevention of Intrinsic Spastic Thumb-in-Palm Deformity

Purpose

The superficialis to profundus (STP) tendon transfer is an effective procedure to correct a spastic clenched fist deformity in a nonfunctional upper extremity. An intrinsic thumb-in-palm (TIP) deformity, caused by increased activity in the adductor pollicis and flexor pollicis brevis muscles, commonly becomes apparent after an STP procedure. The goal of this study was to investigate the efficacy of median nerve recurrent branch neurectomy, done at the time of STP and in concert with an ulnar motor nerve neurectomy and wrist arthrodesis, in the prevention of an intrinsic TIP deformity caused by spastic thenar muscles.

Methods

We retrospectively evaluated a consecutive series of 23 patients with upper motor neuron syndrome who underwent an STP transfer performed by a single surgeon at our institution. Group 1 included 11 consecutive patients who underwent an STP, ulnar nerve motor branch neurectomy, and wrist arthrodesis. Group 2 included 12 consecutive patients who underwent the same procedures with the addition of a neurectomy of the recurrent median nerve. We examined outcomes including development of a postoperative intrinsic TIP deformity, resolution of hygiene issues, and the need for additional surgery to correct the remaining deformities.

Results

Patients were observed for an average of 16.1 months. In group 1, 5 of 11 patients developed an intrinsic TIP deformity, compared with 2 of 12 in group 2. Hygiene-related issues resolved in 8 of 11 patients in group 1 and 10 of 12 patients in group 2. There were no wound infections. In the 7 patients with postoperative intrinsic TIP deformity (5 in group 1 and 2 in group 2), 5 elected to have additional surgery. Of the 7 patients, 2 declined additional surgery because their deformities were mild and their hygiene issues had resolved.

Conclusions

Median nerve recurrent branch neurectomy appears to be a useful adjunct to STP with ulnar motor branch neurectomy and wrist arthrodesis in the prevention of an intrinsic TIP deformity in the nonfunctional hand.

Type of study/level of evidence

Therapeutic III.

Key words: Recurrent median neurectomy, spastic thumb-in-palm, superficialis to profundus